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Liu L, Zhou S, Song D, Li Z, Yang S, Wu Y, Zhang G, Tang D, Liu J, Liao H, Zhang C. The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China. World J Surg Oncol 2024; 22:150. [PMID: 38844951 PMCID: PMC11155079 DOI: 10.1186/s12957-024-03425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/24/2024] [Indexed: 06/10/2024] Open
Abstract
PURPOSE To evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables. METHODS We retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from immediate and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Sixteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP. RESULTS After eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction(P < 0.001), and at 3 mo (P < 0.001), 6 mo (P < 0.001) and 12 mo (P = 0.009) after surgery. CONCLUSION MUL is a significant independent factor that can contribute to short and long term UC recovery post-LRP, which may assist clinicians and their patients in counseling of treatment.
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Affiliation(s)
- Lei Liu
- Department of Urology, People's Hospital of Dayi County, Chengdu, 611300, China
| | - Shukui Zhou
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Dandan Song
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Zeng Li
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Shengke Yang
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yi Wu
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Guiying Zhang
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Duocai Tang
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Junfeng Liu
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Hong Liao
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.
| | - Chuan Zhang
- Department of Urology, People's Hospital of Dayi County, Chengdu, 611300, China.
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Geraghty K, Keane K, Davis N. Systematic review on urinary continence rates after robot-assisted laparoscopic radical prostatectomy. Ir J Med Sci 2024; 193:1603-1612. [PMID: 38200383 PMCID: PMC11128392 DOI: 10.1007/s11845-023-03603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The objective was to investigate the current evidence and discern urinary continence rates post robot-assisted laparoscopic radical prostatectomy (RALP). METHODS A systematic review of the literature was carried out, searching the Embase, Scopus and PubMed databases between 1 January 2000 and 1 May 2020. The search terms "Robotic prostatectomy AND continence" were employed. Articles were selected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Statistical analysis was performed using the programme R; cumulative analysis of percentage of men continent was calculated. RESULTS A total of 3101 abstracts and 50 full text articles were assessed, with 22 publications included (n = 2813 patients). There were 21 randomised controlled trials and one partly randomised controlled trial with four publications comparing RALP to other prostate cancer treatments. Thirteen studies explored different RALP techniques, and five studies examined vesicourethral anastomosis (VUA). There were statistically significant improvements in early urinary continence rates in three studies analysing reconstructive techniques (83% vs 60%, p = 0.04; 26.5% vs 15.4%, p = 0.016; 77% vs 44.1%, p ≤ 0.001). Long-term continence rates were not significantly improved across all studies assessing reconstruction. One study comparing RALP vs laparoscopic radical prostatectomy (LRP) demonstrated a statistically significant improvement in continence at 3 months (80% vs 73.3%, p < 0.001); 6 months (83.3% vs 81.4%, p < 0.001); 12 months (95% vs 83.3%, p < 0.001) and 24 months (96.7% vs 85%, p < 0.001). Early continence was less favourable for RALP when compared to brachytherapy (BT) patients at 3 months (86% vs 98.7%, p < 0.05) and 6 months (90.5% vs 98.7%, p < 0.05). CONCLUSION Early continence rates were improved across numerous techniques in RALP. These results were not translated into significantly improved long-term outcomes. Continence rates following RALP were favourable compared to LRP, similar to ORP and less favourable compared to BT. Our findings suggest that post-RALP continence can be further improved with alterations in robotic technique.
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Affiliation(s)
| | - Kevin Keane
- Urology Department, Beaumont Hospital, Dublin, Ireland
| | - Niall Davis
- Urology Department, Beaumont Hospital, Dublin, Ireland
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Checcucci E, De Cillis S, Alladio E, Piramide F, Volpi G, Granato S, Zamengo D, Bignante G, Amparore D, Piana A, Manfredi M, Vallariello E, Stura I, Di Dio M, Autorino R, Porpiglia F, Fiori C. Ten-year functional and oncological outcomes of a prospective randomized controlled trial comparing laparoscopic versus robot-assisted radical prostatectomy. Prostate 2024; 84:832-841. [PMID: 38572570 DOI: 10.1002/pros.24702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Among prostate cancer (PCa) treatment options, mini-invasive surgical approaches have gained a wide diffusion in the last decades. The aim of this study was to present oncological, functional, and quality of life data after 10 years of follow-up of a prospective randomized controlled trial (RCT) (ISRCTN11552140) comparing robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) for the treatment of PCa. METHODS Patients with localized PCa were randomized to undergo LRP or RARP between January 2010 and January 2011. Functional (continence and potency) and oncological (prostate-specific antigen, biochemical recurrence [BCR] and BCR-free survival [BCRFS]) variables were evaluated. BCRFS curves were estimated by the Kaplan-Meier method and compared using the log-rank test. Machine learning partial least square-discriminant analysis (PLS-DA) was used to identify the variables characterizing more the patients who underwent RARP or LRP. RESULTS Seventy-five of the originally enrolled 120 patients remained on follow-up for 10 years; 40 (53%) underwent RARP and 35 (47%) LRP. Continence and potency recovery rates did not show significant differences (p = 0.068 and p = 0.56, respectively), despite a Δ12% for continence and Δ8% for potency in favor of the robotic approach. However, the quality of continence (in terms of International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] score) and erection (in terms of International Index of Erectile Function-5 [IIEF-5] score) was significantly better after 10 years in the robotic group (p = 0.02 and p < 0.001). PLS-DA revealed that LRP was characterized by the worst functional-related outcomes analyzing the entire follow-up period. Four (10%) and six (17%) patients experienced BCR in RARP and LRP groups, respectively (p = 0.36), with an overall 10-year BCR-free survival of 88% and 78% (p = 0.16). CONCLUSIONS Comparable continence and potency rates were observed between RARP and LRP after a 10-year follow-up. However, the RARP group exhibited superior totally dry rate and erection quality. No difference in terms of oncological outcomes was found.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Sabrina De Cillis
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Federico Piramide
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Davide Zamengo
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Bignante
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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Vermassen T, Lumen N, Van Praet C, Callewaert N, Delanghe J, Rottey S. The Association between Urine N-Glycome and Prognosis after Initial Therapy for Primary Prostate Cancer. Biomedicines 2024; 12:1039. [PMID: 38791001 PMCID: PMC11118943 DOI: 10.3390/biomedicines12051039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
Next to prostate-specific antigen, no biochemical biomarkers have been implemented to guide patient follow-up after primary therapy for localized prostate cancer (PCa). We evaluated the prognostic potential of urine N-glycome in terms of event-free survival (EFS) in patients undergoing primary therapy for PCa. The prognostic features of the urine N-glycosylation profile at diagnosis, assessed in 77 PCa patients, were determined in terms of EFS next to standard clinical parameters. The majority of patients were diagnosed with International Society of Urological Pathology grade ≤ 3 (82%) T1-2 tumors (79%) and without pelvic lymph node invasion (96%). The patients underwent active surveillance (14%), robot-assisted laparoscopic prostatectomy (48%), or external beam radiotherapy (37%). Decreased ratios of biantennary core-fucosylation were noted in patients who developed an event, which was linked to a shorter EFS in both the intention-to-treat cohort and all subcohort analyses. Combining the urine N-glycan biomarker with the D'Amico Risk Classification for PCa resulted in an improved nomogram for patient classification after primary therapy. The rate of urine N-glycan biantennary core-fucosylation, typically linked to more aggressive disease status, is lower in patients who eventually developed an event following primary therapy and subsequently in patients with a worse EFS. The combination of urine N-glycan biomarkers together with clinical parameters could, therefore, improve the post-therapy follow-up of patients with PCa.
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Affiliation(s)
- Tijl Vermassen
- Department Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
- Biomarkers in Cancer, Department Basic and Applied Medicine, Ghent University, 9000 Ghent, Belgium
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
| | - Nicolaas Lumen
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Department Urology (ERN eUROGEN Accredited Centre), Ghent University Hospital, 9000 Ghent, Belgium
- Uro-Oncology Research Group, Department Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Charles Van Praet
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Department Urology (ERN eUROGEN Accredited Centre), Ghent University Hospital, 9000 Ghent, Belgium
- Uro-Oncology Research Group, Department Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Nico Callewaert
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Department Molecular Biomedical Research, VIB-UGent Center for Medical Biotechnology, 9052 Ghent, Belgium
- Department Biochemistry and Microbiology, Ghent University, 9000 Ghent, Belgium
| | - Joris Delanghe
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Department Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Sylvie Rottey
- Department Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
- Biomarkers in Cancer, Department Basic and Applied Medicine, Ghent University, 9000 Ghent, Belgium
- Cancer Research Institute Ghent, 9000 Ghent, Belgium
- Drug Research Unit Ghent, Ghent University Hospital, 9000 Ghent, Belgium
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Zeng N, Sun JX, Liu CQ, Xu JZ, An Y, Xu MY, Zhang SH, Zhong XY, Ma SY, He HD, Wang SG, Xia QD. Knowledge mapping of application of image-guided surgery in prostate cancer: a bibliometric analysis (2013-2023). Int J Surg 2024; 110:2992-3007. [PMID: 38445538 DOI: 10.1097/js9.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Image-guided surgery (IGS) refers to surgery navigated by medical imaging technology, helping doctors better clarify tumor boundaries, identify metastatic lymph nodes and preserve surrounding healthy tissue function. Recent studies have provided expectable momentum of the application of IGS in prostate cancer (PCa). The authors aim to comprehensively construct a bibliometric analysis of the application of IGS in PCa. METHOD The authors searched publications related to application of IGS in PCa from 2013 to 2023 on the web of science core collection (WoSCC) databases. VOSviewer, CiteSpace, and R package 'bibliometrix' were used for bibliometric analysis. RESULTS Two thousand three eighty-nine articles from 75 countries and 2883 institutions led by the United States were included. The number of publications related to the application of IGS in PCa kept high in the last decade. Johns Hopkins University is the top research institutions. Journal of Nuclear Medicine has the highest popularity as the selection of journal and co-cited journal. Pomper Martin G. had published the most paper. Ali Afshar-Oromieh was co-cited most frequently. The clinical efficacy of PSMA-PET/CT in PCa diagnosis and treatment are main topics in this research field, with emerging focuses on the use of fluorescence imaging guidance technology in PCa. 'PSMA' and 'PET/CT' are the main keywords as long-term research hotspots. CONCLUSION This study is the first bibliometric analysis of researches on application of IGS in PCa with three recognized bibliometric software, providing an objective description and comprehensive guidance for the future relevant investigations.
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Affiliation(s)
- Na Zeng
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, People's Republic of China
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Coşarcan SK, Gürkan Y, Manici M, Özdemir İ, Kılıç M, Esen T, Erçelen Ö. The effect of ultrasound-guided rectus sheath block on postoperative analgesia in robot assisted prostatectomy: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e37975. [PMID: 38669407 PMCID: PMC11049694 DOI: 10.1097/md.0000000000037975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/26/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations. METHODS This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 µg fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded. RESULTS Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points. CONCLUSION RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.
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Affiliation(s)
- Sami Kaan Coşarcan
- Department of Anesthesiology, VKV American Hospital, Istanbul, Turkey
- Department of Anesthesiology and Reanimation, Koç University, School of Medicine, Istanbul, Turkey
| | - Yavuz Gürkan
- Department of Anesthesiology and Reanimation, Koç University Hospital, School of Medicine, Istanbul, Turkey
| | - Mete Manici
- Department of Anesthesiology and Reanimation, Koç University Hospital, School of Medicine, Istanbul, Turkey
| | - İrem Özdemir
- Department of Anesthesiology and Algology Clinic, Koç University Hospital, School of Medicine, Istanbul, Turkey
| | - Mert Kılıç
- Department of Urology, VKV American Hospital, Istanbul, Turkey
| | - Tarik Esen
- Department of Urology, VKV American Hospital, Istanbul, Turkey
- Department of Urology, Koç University Hospital, School of Medicine, Istanbul, Turkey
| | - Ömür Erçelen
- Department of Anesthesiology and Algology Clinic, Koç University Hospital, School of Medicine, Istanbul, Turkey
- Department of Anesthesiology and Algology Clinic, VKV American Hospital, Istanbul, Turkey
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Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, Eberli D, De Meerleer G, De Santis M, Farolfi A, Gandaglia G, Gillessen S, Grivas N, Henry AM, Lardas M, van Leenders GJLH, Liew M, Linares Espinos E, Oldenburg J, van Oort IM, Oprea-Lager DE, Ploussard G, Roberts MJ, Rouvière O, Schoots IG, Schouten N, Smith EJ, Stranne J, Wiegel T, Willemse PPM, Tilki D. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2024:S0302-2838(24)02254-1. [PMID: 38614820 DOI: 10.1016/j.eururo.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND AND OBJECTIVE The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines provide recommendations for the management of clinically localised prostate cancer (PCa). This paper aims to present a summary of the 2024 version of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on the screening, diagnosis, and treatment of clinically localised PCa. METHODS The panel performed a literature review of all new data published in English, covering the time frame between May 2020 and 2023. The guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence. KEY FINDINGS AND LIMITATIONS A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for selected favourable intermediate-risk patients with International Society of Urological Pathology grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term intensified hormonal treatment. CONCLUSIONS AND CLINICAL IMPLICATIONS The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. These PCa guidelines reflect the multidisciplinary nature of PCa management. PATIENT SUMMARY This article is the summary of the guidelines for "curable" prostate cancer. Prostate cancer is "found" through a multistep risk-based screening process. The objective is to find as many men as possible with a curable cancer. Prostate cancer is curable if it resides in the prostate; it is then classified into low-, intermediary-, and high-risk localised and locally advanced prostate cancer. These risk classes are the basis of the treatments. Low-risk prostate cancer is treated with "active surveillance", a treatment with excellent prognosis. For low-intermediary-risk active surveillance should also be discussed as an option. In other cases, active treatments, surgery, or radiation treatment should be discussed along with the potential side effects to allow shared decision-making.
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Affiliation(s)
- Philip Cornford
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK.
| | | | | | | | | | - Julie Darraugh
- European Association of Urology, Arnhem, The Netherlands
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Maria De Santis
- Department of Urology, Universitätsmedizin Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Nikolaos Grivas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | | | - Matthew Liew
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | | | - Jan Oldenburg
- Akershus University Hospital (Ahus), Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands
| | | | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - Olivier Rouvière
- Department of Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, UFR Lyon-Est, Lyon, France
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Emma J Smith
- European Association of Urology, Arnhem, The Netherlands
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital-Västra Götaland, Gothenburg, Sweden
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul M Willemse
- Department of Urology, Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
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8
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Roberts NA, Esler R, Pearce A, Wyld D, Smith M, Woollett K, Mazariego C, Roberts MJ. Exploring Unmet Needs in Prostate Cancer Care: A Cross-sectional Descriptive Study. EUR UROL SUPPL 2024; 62:36-42. [PMID: 38585211 PMCID: PMC10998272 DOI: 10.1016/j.euros.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective Prostate cancer, the most common cancer among men worldwide, has significant impact on quality of life. Supportive care needs for those affected by prostate cancer are not well understood. This study aims to describe patient-reported unmet needs and explore supportive care priorities of men treated for prostate cancer. Methods A cross-sectional survey was distributed to all men who had accessed prostate cancer services (including surgical, radiation, and medical oncology treatment modalities) at a tertiary hospital. The survey included qualitative questions exploring patient experience and a validated patient-reported outcome measure (Supportive Care Needs Survey Short Form 34). Clinical information was collected. Analyses included, descriptive statistics, multivariate logistic regression models and qualitative analyses using a framework method. Key findings and limitations A total of 162 participants provided survey data. Domains about information, self-management, and sexual function were the highest ranked items with unmet needs. A qualitative analysis also identified "relationships", "information", and "the value of hindsight" constructs. Participants who identified three or more unmet needs expressed treatment regret (odds ratio 5.92, 1.98-22.23, p = 0.01). Conclusions and clinical implications Understanding the unmet needs of patients may better inform supportive care interventions that address what is important to patients. Importantly, participants valued relationships. There may be opportunities to better meet the needs of patients by improving access to information and self-management resources, particularly around sexuality. Further research is warranted. Patient summary Prostate cancer and its treatment impacts are not well understood. Prioritisation of relationships and improving access to information and self-management resources are important. Further attention to prostate cancer supportive care in clinical practice is needed.
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Affiliation(s)
- Natasha A. Roberts
- Centre for Clinical Research, Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Herston, QLD, Australia
| | - Rachel Esler
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Adam Pearce
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - David Wyld
- Centre for Clinical Research, Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Michael Smith
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Kaylene Woollett
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Carolyn Mazariego
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Kings Cross, NSW, Australia
| | - Matthew J. Roberts
- Centre for Clinical Research, Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Cancer Care Services, Surgery and Peri-operative Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
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9
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Kubota M, Kawakita M, Yoshida S, Kimura H, Sumiyoshi T, Yamasaki T, Okumura K, Yoshimura K, Matsui Y, Sugiyama K, Okuno H, Segawa T, Shimizu Y, Ito N, Onishi H, Ishitoya S, Soda T, Yoshida T, Uemura Y, Iwamura H, Okubo K, Suzuki R, Fukuzawa S, Akao T, Kurahashi R, Shimatani K, Sekine Y, Negoro H, Akamatsu S, Kamoto T, Ogawa O, Kawakami K, Kobayashi T, Goto T. Effects of thienopyridine class antiplatelets on bleeding outcomes following robot-assisted radical prostatectomy. Sci Rep 2024; 14:5847. [PMID: 38462660 PMCID: PMC10925592 DOI: 10.1038/s41598-024-56570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/08/2024] [Indexed: 03/12/2024] Open
Abstract
This study aimed to assess the effects of thienopyridine-class antiplatelet agents (including ticlopidine, clopidogrel, and prasugrel) on bleeding complications in patients who underwent robot-assisted radical prostatectomy. This cohort study used a database for robot-assisted radical prostatectomy at 23 tertiary centers nationwide between 2011 and 2022. Patients who received thienopyridines (thienopyridine group) were compared with those who received aspirin monotherapy (aspirin group). The primary outcome was the incidence of bleeding complications. High-grade complications were defined as Clavien-Dindo grade III or higher. The risks of these outcomes were evaluated using inverse probability of treatment weighted regression models. The study results demonstrated that thienopyridine therapy was associated with a higher risk of overall bleeding complications (OR: 3.62, 95%CI 1.54-8.49). The increased risks of the thienopyridine group were detected for low-grade bleeding complications (OR: 3.20, 95%CI 1.23-8.30) but not for high-grade bleeding complications (OR: 5.23, 95%CI 0.78-34.9). The increased risk of bleeding complications was not observed when thienopyridine was discontinued (OR: 2.52, 95%CI 0.83-7.70); however, it became apparent when it was continued perioperatively (OR: 4.35, 95%CI 1.14-16.61). In conclusion, thienopyridine increased the incidence of bleeding complications, particularly low-grade bleeding complications, following robot-assisted radical prostatectomy. These bleeding effects emerged when thienopyridine was continued perioperatively.
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Affiliation(s)
- Masashi Kubota
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Hiroko Kimura
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Sumiyoshi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshinari Yamasaki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | | | - Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Kyohei Sugiyama
- Department of Urology, Kurashiki Central Hospital, Okayama, Japan
| | - Hiroshi Okuno
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Yosuke Shimizu
- Department of Urology, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
| | - Noriyuki Ito
- Department of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hiroyuki Onishi
- Department of Urology, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Satoshi Ishitoya
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | - Takeshi Soda
- Department of Urology, Kitano Hospital, Osaka, Japan
| | - Toru Yoshida
- Department of Urology, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Yuichi Uemura
- Department of Urology, Toyooka Hospital, Toyooka, Hyogo, Japan
| | - Hiroshi Iwamura
- Department of Urology, Himeji Medical Center, Himeji, Hyogo, Japan
| | | | - Ryosuke Suzuki
- Department of Urology, Numazu City Hospital, Shizuoka, Japan
| | - Shigeki Fukuzawa
- Department of Urology, Shimada General Medical Center, Shizuoka, Japan
| | - Toshiya Akao
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Ryoma Kurahashi
- Department of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kimihiro Shimatani
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Yuya Sekine
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiromitsu Negoro
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | | | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takayuki Goto
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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10
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Marra G, Tappero S, Barletta F, Marquis A, Allasia M, Oderda M, Dariane C, Timsit MO, Branchereau J, Mesnard B, Tilki D, Olsburgh J, Kulkarni M, Kasivisvanathan V, Lebacle C, Breda A, Galfano A, Gandaglia G, Briganti A, Montorsi F, Biancone L, Gontero P. Radical Prostatectomy for Nonmetastatic Prostate Cancer in Renal Transplant Recipients: Outcomes for a Large Contemporary Cohort and a Matched Comparison to Patients Without a Transplant. Eur Urol Focus 2024:S2405-4569(24)00042-7. [PMID: 38453584 DOI: 10.1016/j.euf.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND OBJECTIVE It is unknown whether renal transplant receipt (RTR) status can affect perioperative and oncological outcomes of radical prostatectomy (RP). Our aim was to evaluate oncological and functional outcomes of RTR patients treated with RP for cN0M0 prostate cancer (PCa) via comparison with a no-RTR cohort. METHODS RTR patients who had undergone RP at seven European institutions during 2001-2022 were identified. A multi-institutional cohort of no-RTR patients treated with RP during 2004-2022 served as the comparator group. Propensity score matching (PSM) at a ratio of 1:4 was used to match no-RTR patients to the RTR cohort according to age, prostate-specific antigen, and final pathology features. We used Kaplan-Meier plots and multivariable Cox, logistic, and Poisson log-linear regression models to test the outcomes of interest. KEY FINDINGS AND LIMITATIONS After PSM, we analyzed data for 102 RTR and 408 no-RTR patients. RTR patients experienced higher estimated blood loss (EBL), longer length of hospital stay (LOS) and time to catheter removal, higher postoperative complication rates, and a lower continence recovery rate (all p < 0.001). On multivariable analyses, RTR independently predicted unfavorable operative time (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.18-1.25), LOS (OR 1.57, 95% CI 1.32-1.86), EBL (OR 2.24, 95% CI 2.18-2.30), and time to catheter removal (OR 1.93, 95% CI 1.68-2.21), but not complications or continence recovery. There were no significant differences for any oncological outcomes (biochemical recurrence, local or systemic progression) between the RTR and no-RTR groups. While no PCa deaths were recorded, the overall mortality rate was significantly higher in the RTR group (17% vs 0.5%, p < 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS Although RP is feasible for RTR patients, the procedure poses non-negligible surgical challenges, with longer operative time and LOS and higher EBL, but no major differences in terms of complications and continence recovery. The RTR group had similar oncological outcomes to the no-RTR group but significantly higher overall mortality related to causes other than PCa. Therefore, careful selection for RP is required among candidates with previous RTR. PATIENT SUMMARY Removal of the prostate for prostate cancer is possible in patients who have had a kidney transplant, and cancer control outcomes are comparable to those for the general population. However, transplant patients have a higher risk of death from causes other than prostate cancer and the prostate surgery is likely to be more challenging.
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Affiliation(s)
- Giancarlo Marra
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy.
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Marquis
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Allasia
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Benoit Mesnard
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Derya Tilki
- Department of Urology, Martini Klinik, Hamburg, Germany
| | | | | | | | - Cedric Lebacle
- Department of Urology, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, Paris, France
| | - Alberto Breda
- Department of Urology, Fundacio Puigvert, Barcelona, Spain
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Biancone
- Department of Nephrology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
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11
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Devine M, Morris M, Kavanagh D. Transferability of Technical Skills Across Robotic Surgery Platforms: A Scoping Review. Cureus 2024; 16:e56429. [PMID: 38638798 PMCID: PMC11024662 DOI: 10.7759/cureus.56429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
As the application of robotic approaches to surgery continues to broaden, new consoles have been introduced to the market. Due to the global utilization of a single platform, previously validated curricula have not been assessed on new robotic systems. Surgery by its nature occurs in a high-stakes environment, potentially exacerbated by non-standardized robotic systems. The aim of this review is to critique the evidence available regarding the transferability of technical skills across robotic platforms. A scoping review utilizing the Medline (Pubmed) and Cochrane Databases was conducted. Full texts were reviewed and appraised. Selected articles were eligible for inclusion if they investigated the ability or implications of the transfer of skill across robotic platforms. Data was extracted, coded inductively, and themes synthesized. NVIVO software was used as an adjunct for this qualitative analysis. Following the removal of duplicates a total of 278 papers were screened according to the eligibility criteria. Fifty full-text articles were reviewed and four met the criterion for inclusion. Novices' performance across platforms was comparable. Increasing levels of prior robotic experience revealed an improvement in technical performance on a novel robotic platform. Safety metrics appear comparable across systems. Quantifying learning curves across robotic platforms and their implications for the robotic surgeon in training remains to be determined. Future research needs to address the gaps in the literature by clearly defining the extent of technical skills transfer between robotic platforms. These factors will guide the next iteration of surgical training curriculums and regulations for robotic surgery.
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Affiliation(s)
- Michael Devine
- Department of Surgical Affairs, Royal College of Surgeons in Ireland/Hermitage Medical Clinic, Dublin, IRL
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Dara Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, IRL
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12
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Davidson T, Sjödahl R, Aldman Å, Lennmarken C, Kammerlind AS, Theodorsson E. Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes. Scand J Surg 2024; 113:13-20. [PMID: 37555486 DOI: 10.1177/14574969231186283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND AND AIM The purpose of this study was to evaluate clinical experiences and cost-effectiveness by comparing robot-assisted surgery with laparoscopic- or open surgery for pelvic and renal operations. METHODS A narrative review was carried out. RESULTS When using robotic-assisted surgery, oncological and functional results are similar to after laparoscopic or open surgery. One exception may be a shorter survival in cancer of the cervix uteri. In addition, postoperative complications after robotic-assisted surgery are similar, bleeding and transfusion needs are less, and the hospital stay is shorter but the preparation of the operating theater before and after surgery and the operation times are longer. Finally, robot-assisted surgery has, in several studies, been reported to be not cost-effective primarily due to high investment costs. However, more recent studies provide improved cost-effectiveness estimates due to more effective preparation of the operating theater before surgery, improved surgeon experience, and decreased investment costs. CONCLUSIONS Complications and functional and oncological outcomes after robot-assisted surgery are similar to open surgery and laparoscopic surgery. The cost-effectiveness of robot-assisted surgery is likely to equal or surpass the alternatives.
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Affiliation(s)
- Thomas Davidson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE 58183, Linkoping Sweden
| | - Rune Sjödahl
- Division of Surgery and Clinical Experimental Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Åke Aldman
- Department of Surgery, Region Kalmar län, Kalmar, Sweden
| | - Claes Lennmarken
- Department for Medical Quality, Region Östergötland, Linkoping, Sweden
| | - Ann-Sofi Kammerlind
- Futurum, Jönköping, Sweden Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Elvar Theodorsson
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
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13
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Worst TS, Surovtsova I, Vogel T, Zauser M, Neuberger MC, Wessels F, Michel MS, Nuhn P, Morakis P. [Incidence, therapy, and prognosis of prostate cancer in Baden-Württemberg: analysis based on cancer registry data]. UROLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00120-024-02275-w. [PMID: 38316650 DOI: 10.1007/s00120-024-02275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Prostate cancer (PCa) is the most common solid tumor in men in Germany. Collection of epidemiological and clinical data has been centralized for several years due to legal requirements via the state cancer registries. Thus, the reporting of diagnosis, therapy, and progression of cancer is obligatory in Germany. These data needs to be processed based on the questions of the treating physicians. OBJECTIVES Intention of this work was to present the development of new cases, disease stages, treatment procedures and prognosis of PCa in Baden-Württemberg (BW). METHODS For this purpose, data of the cancer registry BW regarding patients with PCa first diagnosed between 2013 and 2021 were evaluated. The evaluation was performed using descriptive statistics, Χ2 test and Kaplan-Meier analysis. RESULTS A total of 84,347 new diagnoses of PCa were reported. Clinical stage was present in 55.3% of patients. Assignment by International Society of Urological Pathology (ISUP) groups was present in 75.7%. A steady increase in primary diagnosis was evident through 2019. The proportion of primary metastatic disease decreased (2013: 19.6% vs. 2021: 12.0%), and the proportion of localized tumors increased (2013: 65.5% vs. 2021: 77.1%). Radical prostatectomy (RP) dominated the treatment of localized tumors with a mean of 60.1%. The proportion of robot-assisted surgery increased from 23.7% (2013) to 60.8% (2021) with a decrease in the R1 rate from 34.8 to 26.2%. Progression-free survival correlated closely with tumor stage and ISUP group. CONCLUSION An increase in PCa cases and a decrease of advanced tumors were observed. Treatment was mostly surgical in localized stages, with increasing proportion of robotic-assisted RP. Early diagnosis and treatment are critical for long-term prognosis.
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Affiliation(s)
- Thomas Stefan Worst
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Irina Surovtsova
- Klinische Landesregisterstelle GmbH, Krebsregister Baden-Württemberg, Birkenwaldstraße 149, 70191, Stuttgart, Deutschland
| | - Tilo Vogel
- Geschäftsstelle Qualitätskonferenzen bei der Klinischen Landesregisterstelle GmbH, Krebsregister Baden-Württemberg, Birkenwaldstraße 149, 70191, Stuttgart, Deutschland
| | - Martin Zauser
- Klinische Landesregisterstelle GmbH, Krebsregister Baden-Württemberg, Birkenwaldstraße 149, 70191, Stuttgart, Deutschland
| | - Manuel Christian Neuberger
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Frederik Wessels
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Maurice Stephan Michel
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Philipp Nuhn
- Klinik für Urologie Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - Philipp Morakis
- Geschäftsstelle Qualitätskonferenzen bei der Klinischen Landesregisterstelle GmbH, Krebsregister Baden-Württemberg, Birkenwaldstraße 149, 70191, Stuttgart, Deutschland
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14
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Hamdy FC, Donovan JL. Reply to Bernardo Rocco and Maria Chiara Sighinolfi's Letter to the Editor re: Freddie C. Hamdy, Jenny L. Donovan, J. Athene Lane, et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med 2023;388:1547-58. Eur Urol 2024; 85:e41-e42. [PMID: 37659961 DOI: 10.1016/j.eururo.2023.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - Jenny L Donovan
- Department of Population Health Sciences, University of Bristol, Bristol, UK
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15
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Rabinowitz J, Kinnear N, O'Callaghan M, Hennessey D, Shafi F, Fuller A, Ibrahim M, Lane T, Adshead J, Vasdev N. Systematic review of the ophthalmic complications of robotic-assisted laparoscopic prostatectomy. J Robot Surg 2024; 18:46. [PMID: 38240959 DOI: 10.1007/s11701-023-01771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
This study aims to review ophthalmic injuries sustained during of robotic-assisted laparoscopic prostatectomy (RALP). A search of Medline, Embase, Cochrane and grey literature was performed using methods registered a priori. Eligible studies were published 01/01/2010-01/05/2023 in English and reported ophthalmic complications in cohorts of > 100 men undergoing RALP. The primary outcome was injury incidence. Secondary outcomes were type and permanency of ophthalmic complications, treatments, risk factors and preventative measures. Nine eligible studies were identified, representing 100,872 men. Six studies reported rates of corneal abrasion and were adequately homogenous for meta-analysis, with a weighted pooled rate of 5 injuries per 1000 procedures (95% confidence interval 3-7). Three studies each reported different outcomes of xerophthalmia, retinal vascular occlusion, and ophthalmic complications unspecified in 8, 5 and 2 men per 1000 procedures respectively. Amongst identified studies, there were no reports of permanent ophthalmic complications. Injury management was poorly reported. No significant risk factors were reported, while one study found African-American ethnicity protective against corneal abrasion (0.4 vs. 3.9 per 1000). Variables proposed (but not proven) to increase risk for corneal abrasion included steep Trendelenburg position, high pneumoperitoneum pressure, prolonged operative time and surgical inexperience. Compared with standard of care, occlusive eyelid dressings (23 vs. 0 per 1000) and foam goggles (20 vs. 1.3 per 1000) were found to reduce rates of corneal abrasion. RALP carries low rates of ophthalmic injury. Urologists should counsel the patient regarding this potential complication and pro-actively implement preventative strategies.
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Affiliation(s)
| | - Ned Kinnear
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK.
- Flinders Medical Centre, Adelaide, Australia.
| | - Michael O'Callaghan
- Flinders Medical Centre, Adelaide, Australia
- Flinders University, Adelaide, Australia
- University of Adelaide, Adelaide, Australia
| | | | - Fariha Shafi
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | | | | | - Timothy Lane
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - James Adshead
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - Nikhil Vasdev
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
- University of Hertfordshire, Hatfield, UK
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16
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Mian AH, Tollefson MK, Shah P, Sharma V, Mian A, Thompson RH, Boorjian SA, Frank I, Khanna A. Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy. J Clin Med 2024; 13:359. [PMID: 38256493 PMCID: PMC10815957 DOI: 10.3390/jcm13020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.
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Affiliation(s)
- Abrar H. Mian
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ahmed Mian
- Urology Associates of Green Bay, Green Bay, WI 54301, USA
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Abhinav Khanna
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
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Hays SB, Corvino G, Lorié BD, McMichael WV, Mehdi SA, Rieser C, Rojas AE, Hogg ME. Prince and princesses: The current status of robotic surgery in surgical oncology. J Surg Oncol 2024; 129:164-182. [PMID: 38031870 DOI: 10.1002/jso.27536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Robotic surgery has experienced a dramatic increase in utilization across general surgery over the last two decades, including in surgical oncology. Although urologists and gynecologists were the first to show that this technology could be utilized in cancer surgery, the robot is now a powerful tool in the treatment of gastrointestinal, hepato-pancreatico-biliary, colorectal, endocrine, and soft tissue malignancies. While long-term outcomes are still pending, short-term outcomes have showed promise for this technologic advancement of cancer surgery.
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Affiliation(s)
- Sarah B Hays
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Gaetano Corvino
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Benjamin D Lorié
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - William V McMichael
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Syed A Mehdi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Caroline Rieser
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Aram E Rojas
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Melissa E Hogg
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
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Zamora V, Garin O, Suárez JF, Gutiérrez C, Guedea F, Cabrera P, Castells M, Herruzo I, Fumadó L, Samper P, Ferrer C, Regis L, Pont À, Ferrer M. Comparative effectiveness of new treatment modalities for localized prostate cancer through patient-reported outcome measures. Clin Transl Radiat Oncol 2024; 44:100694. [PMID: 38021091 PMCID: PMC10663757 DOI: 10.1016/j.ctro.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose There is scarce comparative effectiveness research on the new treatment modalities for localized prostate cancer. We aim to compare through Patient-Reported Outcome Measures (PROMs) the impact of active surveillance, robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and real-time brachytherapy, considering side effects (incontinence, irritative/obstructive urinary symptoms, sexual dysfunction and bowel symptoms) and physical and mental health. Materials and Methods Prospective cohort of men diagnosed with clinically localized prostate cancer (age 50-75y, T1-T2, and low risk including Gleason 3 + 4 in T1c) from 18 Spanish hospitals, followed up to 24 months. Treatment decisions were jointly made by patients and physicians (n = 572). The Expanded Prostate cancer Index Composite (EPIC-26) and Short-Form 36 (SF-36v2) were administered through telephone interviews before and three, six, 12, and 24 months after treatment. To account for correlation among repeated measures, generalized estimating equation models were constructed. All analyses were performed with propensity score weights to solve treatment selection bias. Results The PROMs completion rate at 24 months was 95.0 %. Active surveillance entails the fewest side effects, but with significant sexual (0.4 standard deviations [SD], p < 0.001) and physical health deterioration (0.5 SD, p < 0.001); and moderate mental health improvement (0.4 SD, p = 0.001) at 24 months. Compared with active surveillance, RARP presented greater urinary incontinence (p = 0.030), and IMRT and real-time brachytherapy worse bowel symptoms (p = 0.027 and p = 0.007) at 24 months. Conclusions Most side effects of the new treatment modalities seem to be limited to short-term deteriorations, except for moderate-large urinary incontinence in patients who had undergone RARP and moderate bowel deterioration in patients treated with IMRT or with real-time brachytherapy. Furthermore, patients under active surveillance, IMRT, and real-time brachytherapy showed a moderate improvement in mental health.
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Affiliation(s)
- Víctor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - José Francisco Suárez
- Urology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Gutiérrez
- Radiation Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Patricia Cabrera
- Radiation Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Castells
- Urology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ismael Herruzo
- Radiation Oncology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Lluis Fumadó
- Urology Department, Hospital del Mar, Barcelona, Spain
| | - Pilar Samper
- Radiation Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Carlos Ferrer
- Radiation Oncology Department, Hospital Provincial de Castellón, Castellón, Spain
| | - Lucas Regis
- Urology Department, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
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19
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Virk A, Treacy PJ, Thanigasalam R, Leslie S. What are the Most Important Objectives of Patients Undergoing Radical Prostatectomy? A Narrative Review. Res Rep Urol 2023; 15:563-569. [PMID: 38145157 PMCID: PMC10748635 DOI: 10.2147/rru.s444033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/06/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose This study aimed to evaluate what objectives are most important to men undergoing radical prostatectomy to allow treating physicians to personalize perioperative counselling and improve patient quality of life outcomes. Materials and Methods A predefined search protocol of the Medline and Embase databases was performed from database inception to May 2023. The search was limited to English language and full text. All articles with a specific consideration of patient objectives, preferences or reasons for decision to undergo radical prostatectomy were included for review. Results Ten articles out of 375 screened met inclusion criteria for review. All 10 articles utilized a qualitative design and originated across 5 countries across the developed world. A common theme of men placing importance on having their tumor physically removed was found. Methodologies allowing free response beyond predefined categories identified a breadth of considerations including personal circumstance, personal belief and current function in the decision-making process. An investigation on radical prostatectomy performed robotically found some men placed preference on the quicker treatment time with surgery compared to radiation therapy, reflective of shorter recovery times with the robotic approach. Conclusion Variability in results across studies highlights the heterogeneity in patient preferences. Directed investigation of patient objectives with an open-ended questioning approach would personalize the perioperative experience and may improve patient satisfaction and quality of life outcomes.
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Affiliation(s)
- Amandeep Virk
- Department of Uro-Oncology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Patrick-Julien Treacy
- The Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruban Thanigasalam
- Department of Uro-Oncology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
- The Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Scott Leslie
- Department of Uro-Oncology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
- The Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Wu R, Hu M, Zhang P. Predictive value of systematic immune-inflammation index combined with Ki-67 index on prognosis of prostate cancer patients after laparoscopic radical prostatectomy. BMC Urol 2023; 23:210. [PMID: 38114926 PMCID: PMC10729478 DOI: 10.1186/s12894-023-01379-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) presents a wide spectrum. Systemic immune-inflammation index (SII) and Ki-67 index are new biomarkers that can predict prognosis in different types of cancer. We explored the predictive value of their combination on the prognosis of PCa patients after laparoscopic radical prostatectomy (LRP). METHODS In this retrospective study, 290 patients who underwent LRP at Nanjing Lishui People's Hospital between January 2016 and February 2021 were enrolled. They were divided into the good prognosis group (N = 235) and poor prognosis group (N = 55) based on the follow-up results. Both the baseline data and postoperative pathological results were collected. The Ki-67 index was determined using immunohistochemical kits, and the patients were allocated to the SII/Ki-67 index high/low expression groups according to the cut-off values to further analyze their relationship with clinical/pathological data of PCa patients. Logistics multivariate regression analysis was utilized to analyze the independent factors affecting post-LRP prognosis of CPa patients. ROC curve was plotted to assess the predictive value for post-LRP prognosis, and Kaplan-Meier curve/Log-rank were used for analysis. RESULTS Significant differences were found in PSA/Gleason score/T stage/lymph node metastasis/seminal vesicle invasion/neutrophils/lymphocytes/platelets/preoperative SII/Ki-67 index between the good/poor prognosis groups. Preoperative SII/Ki-67 were related to PSA/lymphocytes/platelets in PCa. Seminal vesicle invasion and preoperative SII + Ki-67 index were independent factors affecting post-LRP prognosis. Preoperative SII + Ki-67 index had a better predictive value than preoperative SII or Ki-67 index alone. Patients with high preoperative SII and Ki-67 index levels had an increased risk of poor prognosis after LRP. CONCLUSION Preoperative SII + Ki-67 index had a better predictive value for poor prognosis after LRP than SII or Ki-67 index alone.
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Affiliation(s)
- Rongxin Wu
- Department of Urology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, 86 Chongwen Road, Lishui, Nanjing, 211200, China
| | - Mingjin Hu
- Department of Urology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, 86 Chongwen Road, Lishui, Nanjing, 211200, China
| | - Pei Zhang
- Department of Urology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, 86 Chongwen Road, Lishui, Nanjing, 211200, China.
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21
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Jiang XL, OuYang K, Yang R, Sun JN, Zhang F, Zhao HW. The application of Foley catheter traction technique in extraperitoneal robot-assisted radical prostatectomy. BMC Urol 2023; 23:201. [PMID: 38053112 DOI: 10.1186/s12894-023-01377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES To describe a technique to improve exposure of prostate during extraperitoneal robot-assisted radical prostatectomy (EP-RARP). MATERIAL AND METHODS From March 2020 to June 2022, a total of 41 patients with prior intra-abdominal surgery underwent EP-RARP. Twenty-three patients improved exposure by traction of prostate through urinary catheter. The catheter traction prostatectomy (CTP) group was compared with the standard prostatectomy (SP) group using three robotic arms (18 patients) in terms of estimated blood loss (EBL), operative time, positive surgical margin rate, the recovery rate of urinary continence, Gleason score and postoperative hospital stays. Differences were considered significant when P < 0.05. RESULTS The operative time was lower in the CTP group (109.63 min vs. 143.20 min; P < 0.001). EBL in the CTP group was 178.26 ± 30.70 mL, and in the standard prostatectomy group, it was 347.78 ± 53.53 mL (P < 0.001). No significant differences with regard to postoperative hospital stay, recovery rate of urinary continence, catheterization time and positive surgical margin were observed between both groups. No intraoperative complications occurred in all the patients. After 6 months of follow-up, the Post-op Detectable prostate specific antigen was similar between the two groups. CONCLUSION CTP is a feasible, safe, and valid procedure in EP-RARP. Application of CTP improved the exposure of prostate, reduced operative time and blood loss in comparison with the conventional procedure.
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Affiliation(s)
- Xiao-Lu Jiang
- Medical College of Qingdao University, Qingdao, Shandong, China
| | - Kui OuYang
- Medical College of Qingdao University, Qingdao, Shandong, China
| | - Rui Yang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Jia-Ning Sun
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Feng Zhang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Hong-Wei Zhao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China.
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22
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Yang JW, Kunpeng-Li, Yang L. Comment on: "perioperative results of single-port vs multi-port robotic-assisted radical prostatectomy via peritoneal approach: a meta-analysis" by Lv, et al. J Robot Surg 2023; 17:3049-3050. [PMID: 37584855 DOI: 10.1007/s11701-023-01692-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Jian-Wei Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Kunpeng-Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.
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23
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Wang J, Hu K, Wang Y, Wu Y, Bao E, Wang J, Tan C, Tang T. Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Surg 2023; 17:2617-2631. [PMID: 37721644 DOI: 10.1007/s11701-023-01714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023]
Abstract
The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59 mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59 days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.
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Affiliation(s)
- Junji Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Ke Hu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Yu Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Yinyu Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Erhao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Jiahao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Chunlin Tan
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Tielong Tang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China.
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Sood A, Grauer R, Diaz-Insua M, Tewari AK, Hemal AK, Shrivastava A, Peabody JO, Jeong W, Abdollah F, Rudzinski JK, Andrews JR, Gorin MA, Bhandari M, Menon M. 15-year biochemical failure, metastasis, salvage therapy, and cancer-specific and overall survival rates in men treated with robotic radical prostatectomy for PSA-screen detected prostate cancer. Prostate Cancer Prostatic Dis 2023; 26:778-786. [PMID: 37142635 DOI: 10.1038/s41391-023-00674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND An informed decision regarding a treatment option requires data on its long-term efficacy and side-effect profile. While the side-effects of robotic radical prostatectomy have been well-quantified, the data on its long-term efficacy are lacking. We here provide 15-year oncological outcomes of clinically-localized prostate cancer (CLPCa) patients treated with robot-assisted laparoscopic prostatectomy (RALP). METHODS We treated 1,807 men with CLPCa with RALP between 2001 and 2005 and prospectively collected follow-up data through 2020. We examined the rates of biochemical failure (BCF), metastatic progression, secondary therapy use, PCa-specific mortality (PCSM), and overall survival (OS) using Kaplan-Meier and competing-risk cumulative incidence methods as appropriate. RESULTS The median follow-up was 14.1 years. Six hundred eight and 312 men had D'Amico intermediate- and high-risk disease, respectively. Overall, the 15-year rates of BCF, metastasis, secondary therapy use, PCSM, and OS were 28.1%, 4.0%, 16.3%, 2.5%, and 82.1%, respectively. The rates of oncologic failure increased with increasing D'Amico (preoperative) and Diaz (postoperative) risk scores - BCF, metastasis, and PCSM rates in D'Amico low-, intermediate-, and high-risk groups at 15-years were 15.2%, 38.3%, and 44.1% [BCF], 1.1%, 4.1%, and 13.0% [metastasis], and 0.5%, 3.4%, and 6.6% [PCSM], respectively, and in Diaz risk groups 1, 2, 3, 4, and 5 were 5.5%, 20.6%, 41.8%, 66.9%, and 89.2% [BCF], 0%, 0.5%, 3.2%, 20.5%, and 60.0% [metastasis], and 0%, 0.8%, 0.6%, 13.5%, and 37.5% [PCSM], respectively. The OS rates in D'Amico low-to-high and Diaz 1-to-5 risk groups at 15-years were 85.9%, 78.6%, and 75.2%, and 89.4%, 83.2%, 80.6%, 67.2%, and 23.4%, respectively. CONCLUSIONS Men diagnosed with clinically-localized prostate cancer in the contemporaneous PSA-screening era and treated with RALP achieve durable long-term oncological control. The data reported here (in a risk-stratified manner) represent the longest follow-up after robotic radical prostatectomy, and as such, should be of value when counseling patients regarding expected oncologic outcomes from RALP.
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Affiliation(s)
- Akshay Sood
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mireya Diaz-Insua
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | | | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Firas Abdollah
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jan K Rudzinski
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack R Andrews
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Mani Menon
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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25
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Schepens MH, van Hooff ML, van der Galiën O, Ziedses des Plantes CM, Somford DM, van Leeuwen PJ, Busstra MB, Repping S, Wouters MW, van Limbeek J. Does Centralization of Radical Prostatectomy Reduce the Incidence of Postoperative Urinary Incontinence? EUR UROL SUPPL 2023; 58:47-54. [PMID: 38152486 PMCID: PMC10751543 DOI: 10.1016/j.euros.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 12/29/2023] Open
Abstract
Background On the basis of previous analyses of the incidence of urinary incontinence (UI) after radical prostatectomy (RP), the hospital RP volume threshold in the Netherlands was gradually increased from 20 per year in 2017, to 50 in 2018 and 100 from 2019 onwards. Objective To evaluate the impact of hospital RP volumes on the incidence and risk of UI after RP (RP-UI). Design setting and participants Patients who underwent RP during 2016-2020 were identified in the claims database of the largest health insurance company in the Netherlands. Incontinence was defined as an insurance claim for ≥1 pads/d. Outcome measurements and statistical analysis The relationship between hospital RP volume (HV) and RP-UI was assessed via multivariable analysis adjusted for age, comorbidity, postoperative radiotherapy, and lymph node dissection. Results and limitations RP-UI incidence nationwide and by RP volume category did not decrease significantly during the study period, and 5-yr RP-UI rates varied greatly among hospitals (19-85%). However, low-volume hospitals (≤120 RPs/yr) had a higher percentage of patients with RP-UI and higher variation in comparison to high-volume hospitals (>120 RPs/yr). In comparison to hospitals with low RP volumes throughout the study period, the risk of RP-UI was 29% lower in hospitals shifting from the low-volume to the high-volume category (>120 RPs/yr) and 52% lower in hospitals with a high RP volume throughout the study period (>120 RPs/yr for 5 yr). Conclusions A focus on increasing hospital RP volumes alone does not seem to be sufficient to reduce the incidence of RP-UI, at least in the short term. Measurement of outcomes, preferably per surgeon, and the introduction of quality assurance programs are recommended. Patient summary In the Netherlands, centralization of surgery to remove the prostate (RP) because of cancer has not yet improved the occurrence of urinary incontinence (UI) after surgery. Hospitals performing more than 120 RP operations per year had better UI outcomes. However, there was a big difference in UI outcomes between hospitals.
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Affiliation(s)
- Maike H.J. Schepens
- Department of Biomedical Data Sciences, Leiden UMC, Leiden, The Netherlands
- Healthcare Strategy and Innovation, Cirka BV, Zeist, The Netherlands
| | - Miranda L. van Hooff
- Department of Orthopedic Surgery, Radboud UMC, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Onno van der Galiën
- Department of Strategy and Innovation, Zilveren Kruis Health Insurance, Zeist, The Netherlands
| | | | - Diederik M. Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
| | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Netherlands Prostate Cancer Network, Amsterdam, The Netherlands
| | - Martijn B. Busstra
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sjoerd Repping
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michel W.J.M. Wouters
- Department of Biomedical Data Sciences, Leiden UMC, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Jacques van Limbeek
- Department of Medical Advice, Zilveren Kruis Health Insurance, Zeist, The Netherlands
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Debard C, Margue G, Klein C, Rompré-Brodeur A, Marcq G, Bensadoun H, Robert G, Anidjar M, Bladou F. [Oncological and functional results of focal treatment of localized prostate cancer with HIFU]. Prog Urol 2023; 33:966-973. [PMID: 37770359 DOI: 10.1016/j.purol.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION In recent years, improved diagnosis of prostate cancer has allowed the development of focal therapy, in order to reduce the morbidity of treatments. Our study assesses the medium-term oncological and functional results of FocalOne® HIFU treatment in localized prostate cancer. METHODS This is a retrospective, multicentre study including patients with low- or intermediate-risk localized prostate cancer treated with Focal one HIFU between November 2014 and December 2019. The primary endpoint was the retreatment rate and subgroup analyses were performed to identify predictive factors of retreatment. RESULTS One hundred and thirty-seven patients were included with a median follow-up of 25.5 months. Seventy percent of patients had clinical stage T2, 64% had an ISUP score of 2 or 3 on initial biopsies and 38% were treated with hemi-ablation. Follow-up biopsies were performed in 76.6% of patients during follow-up with 21.8% having clinically significant cancers. The retreatment rate at 24 months was 37.2%, with positive biopsies being the primary criterion for retreatment. Patients with a PSA>8ng/mL had a significantly higher retreatment rate. Finally, morbidity remained acceptable with 5.8% of patients requiring reoperation for complications and 21% for de novo erectile dysfunction. CONCLUSION Our results are in agreement with those of the literature, seeming to indicate a lower morbidity of the focal treatment by HIFU compared to the radical treatments while offering an acceptable oncological control. Prospective randomized trials are ongoing. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- C Debard
- Service d'urologie, CHU de Pellegrin, Bordeaux, France.
| | - G Margue
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - C Klein
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - A Rompré-Brodeur
- Department of Surgery (Division of Urology), Mc Gill University Health Center, Montreal, Canada
| | - G Marcq
- Service d'urologie, hôpital Claude-Huriez, CHU de Lille, Lille, France
| | - H Bensadoun
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - G Robert
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - M Anidjar
- Department of Surgery (Division of Urology), Mc Gill University Health Center, Montreal, Canada
| | - F Bladou
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
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Leitsmann C, Uhlig A, Bremmer F, Mohr MN, Trojan L, Leitsmann M, Reichert M. Impact of multiparametric magnetic resonance imaging targeted biopsy on functional outcomes in patients following robot-assisted laparoscopic radical prostatectomy. Front Surg 2023; 10:1305365. [PMID: 38053718 PMCID: PMC10694190 DOI: 10.3389/fsurg.2023.1305365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction Multiparametric magnetic resonance imaging guided prostate biopsy (mpMRI PBx) leads to a higher rate of successful nerve-sparing in robot-assisted laparoscopic prostatectomy (ns-RALP) for prostate cancer (PCa). This study aimed to evaluate the impact of mpMRI PBx compared to standard ultrasound-guided PBx on functional outcomes focusing on erectile function in patients following ns-RALP. Material and methods All RALPs performed between 01/2016 and 06/2021 were retrospectively stratified according to (attempted) ns vs. non ns RALPs and were then categorized based on the PBx technique (mpMRI PBx vs. standard PBx). We compared RALP outcomes such as pathological tumor stage, rates of secondary nerve resection (SNR) and positive surgical margin status (PSM). Furthermore, we explored the association between PBx-technique and patient-reported outcomes assessed 12 months after RALP using the prospectively collected 26-item Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. Chi-square tests and logistic regression analysis were conducted. Results A total of 849 RALPs included 517 (61%) procedures with (attempted) ns. Among these, 37.5% were diagnosed via preoperative mpMRI PBx. Patients with a preoperative standard PBx had a 57% higher association of PSM (p = 0.030) compared to patients with mpMRI PBx and a 24% higher risk of erectile dysfunction (ED) 12 months post RALP (p = 0.025). When ns was attempted, we observed a significantly higher rate of SNR in patients who underwent a standard PBx compared to those who received a mpMRI PBx (50.8% vs. 26.7%, p < 0.001) prior RALP. In comparison, upgrading occurred more often in the standard PBx group (50% vs. 40% mpMRI PBx, p = 0.008). Conclusion The combination of mpMRI PBx for PCa diagnosis followed by ns-RALP resulted in significantly fewer cases of SNR, better oncological outcomes and reduced incidence of ED 1 year after surgery. This included fewer PSM and a lower rate of postoperative tumor upgrading.
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Affiliation(s)
- Conrad Leitsmann
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Felix Bremmer
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Mirjam Naomi Mohr
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Lutz Trojan
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Mathias Reichert
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
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Piana A, Pecoraro A, Sidoti F, Checcucci E, Dönmez Mİ, Prudhomme T, Bañuelos Marco B, López Abad A, Campi R, Boissier R, Di Dio M, Porpiglia F, Breda A, Territo A. Robot-Assisted Radical Prostatectomy in Renal Transplant Recipients: A Systematic Review. J Clin Med 2023; 12:6754. [PMID: 37959223 PMCID: PMC10649554 DOI: 10.3390/jcm12216754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Robot-assisted radical prostatectomy (RARP) has been shown to achieve excellent oncological outcomes with a low rate of complications in patients with prostate cancer. However, data on RARP in renal transplant recipients (RT) are dispersed. A literature search was conducted through April 2023 using PubMed/Medline, Embase and Web of Science databases. The primary aim was to evaluate the safety, oncologic and clinical outcomes of RARP in RT recipients. The secondary aim was to identify surgical technique modifications required to avoid iatrogenic damage to the transplanted kidney. A total of 18 studies comprising 186 patients met the inclusion criteria. Age at the time of treatment ranged 43-79 years. Biopsy results showed a high prevalence of low- and intermediate-risk disease. Operative time ranged between 108.3 and 400 mins, while estimated blood loss ranged from 30 to 630 mL. Length of hospital stay ranged from 3 to 6 days whereas duration of catheterization was between 5 and 18 days. Perioperative complication rate was 17.1%. Overall positive surgical margin rate was 24.19%, while biochemical recurrence was observed in 10.21% (19/186 patients). Modifications to the standard surgical technique were described in 13/18 studies. Modifications in port placement were described in 7/13 studies and performed in 19/88 (21.6%) patients. Surgical technique for the development of the Retzius space was reported in 13/18 studies. Data on lymphadenectomy were reported in 15/18 studies. Bilateral lymphadenectomy was described in 3/18 studies and performed in 4/89 (4.5%) patients; contralateral lymphadenectomy was reported in 7/18 studies and performed in 41/125 (32.8%) patients. RARP in RTRs can be considered relatively safe and feasible. Oncological results yielded significantly worse outcomes in terms of PSM and BCR rate compared to the data available in the published studies, with an overall complication rate highly variable among the studies included. On the other hand, low graft damage during the procedure was observed. Main criticisms came from different tumor screening protocols and scarce information about lymphadenectomy techniques and outcomes among the included studies.
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Affiliation(s)
- Alberto Piana
- Department of Urology, University of Turin, 10043 Turin, Italy
- Department of Urology, Romolo Hospital, 88821 Rocca di Neto, Italy
| | - Alessio Pecoraro
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (A.P.); (R.C.)
| | - Flavio Sidoti
- Department of Urology, Romolo Hospital, 88821 Rocca di Neto, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Candiolo, 10060 Turin, Italy
| | - Muhammet İrfan Dönmez
- Department of Urology, İstanbul Faculty of Medicine, İstanbul University, 34093 İstanbul, Turkey
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, 31400 Toulouse, France;
| | - Beatriz Bañuelos Marco
- Division Renal Transplantation and Reconstructive Urology, Hospital Universitario El Clínico San Carlos, 28040 Madrid, Spain
| | - Alicia López Abad
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (A.P.); (R.C.)
- Department of Urology, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (A.P.); (R.C.)
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, 13005 Marseille, France;
| | - Michele Di Dio
- Division of Urology, Department of Surgery, Annunziata Hospital, 87100 Cosenza, Italy
| | | | - Alberto Breda
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
| | - Angelo Territo
- Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
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Steffens D, McBride KE, Hirst N, Solomon MJ, Anderson T, Thanigasalam R, Leslie S, Karunaratne S, Bannon PG. Surgical outcomes and cost analysis of a multi-specialty robotic-assisted surgery caseload in the Australian public health system. J Robot Surg 2023; 17:2237-2245. [PMID: 37289337 PMCID: PMC10492768 DOI: 10.1007/s11701-023-01643-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
This study aims to compare surgical outcomes and in-hospital cost between robotic-assisted surgery (RAS), laparoscopic and open approaches for benign gynaecology, colorectal and urological patients and to explore the association between cost and surgical complexity. This retrospective cohort study included consecutive patients undergoing RAS, laparoscopic or open surgery for benign gynaecology, colorectal or urological conditions between July 2018 and June 2021 at a major public hospital in Sydney. Patients' characteristics, surgical outcomes and in-hospital cost variables were extracted from the hospital medical records using routinely collected diagnosis-related groups (DRG) codes. Comparison of the outcomes within each surgical discipline and according to surgical complexity were performed using non-parametric statistics. Of the 1,271 patients included, 756 underwent benign gynaecology (54 robotic, 652 laparoscopic, 50 open), 233 colorectal (49 robotic, 123 laparoscopic, 61 open) and 282 urological surgeries (184 robotic, 12 laparoscopic, 86 open). Patients undergoing minimally invasive surgery (robotic or laparoscopic) presented with a significantly shorter length of hospital stay when compared to open surgical approach (P < 0.001). Rates of postoperative morbidity were significantly lower in robotic colorectal and urological procedures when compared to laparoscopic and open approaches. The total in-hospital cost of robotic benign gynaecology, colorectal and urological surgeries were significantly higher than other surgical approaches, independent of the surgical complexity. RAS resulted in better surgical outcomes, especially when compared to open surgery in patients presenting with benign gynaecology, colorectal and urological diseases. However, the total cost of RAS was higher than laparoscopic and open surgical approaches.
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Affiliation(s)
- Daniel Steffens
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Kate E McBride
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia.
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Nicholas Hirst
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Solomon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Teresa Anderson
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruban Thanigasalam
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Scott Leslie
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Sascha Karunaratne
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Paul G Bannon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Missenden Road, PO Box M40, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- The Baird Institute, Sydney, NSW, Australia
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Territo A, Uleri A, Gallioli A, Gaya JM, Verri P, Basile G, Farré A, Bravo A, Tedde A, Faba ÓR, Palou J, Breda A. Robot-assisted oncologic pelvic surgery with Hugo™ robot-assisted surgery system: A single-center experience. Asian J Urol 2023; 10:461-466. [PMID: 38024434 PMCID: PMC10659963 DOI: 10.1016/j.ajur.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To report the outcomes of intra- and extra-peritoneal robot-assisted radical prostatectomy (RARP) and robot-assisted radical cystectomy (RARC) with Hugo™ robot-assisted surgery (RAS) system (Medtronic, Minneapolis, MN, USA). Methods Data of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported. The primary endpoint of the study was to report the surgical setting of Hugo™ RAS system to perform RARP and RARC. The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes. Results Seventeen patients underwent RARP with a transperitoneal approach, and three with an extraperitoneal approach; and one patient underwent RARC with intracorporeal ileal conduit. No intraoperative complications occurred. Median docking and console time were 12 (interquartile range [IQR] 7-16) min and 185 (IQR 177-192) min for transperitoneal RARP, 15 (IQR 12-17) min and 170 (IQR 162-185) min for extraperitoneal RARP. No intraoperative complications occurred. One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment (Clavien-Dindo Grade 2). In case of transperitoneal RARP, two minor complications occurred (one pelvic hematoma and one urinary tract infection; both Clavien-Dindo Grade 2). Conclusion Hugo™ RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery. We showed the feasibility of RARP both intra- and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.
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Affiliation(s)
| | | | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alba Farré
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandra Bravo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alessandro Tedde
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Óscar Rodríguez Faba
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
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Falagario UG, Knipper S, Pellegrino F, Martini A, Akre O, Egevad L, Grönberg H, Moschovas MC, Bravi CA, Tran J, Heiniger Y, von Kempis A, Schaffar R, Carrieri G, Rochat CH, Mottrie A, Ahlering TE, John H, Patel V, Graefen M, Wiklund P. Prostate Cancer-specific and All-cause Mortality After Robot-assisted Radical Prostatectomy: 20 Years' Report from the European Association of Urology Robotic Urology Section Scientific Working Group. Eur Urol Oncol 2023:S2588-9311(23)00168-2. [PMID: 37661459 DOI: 10.1016/j.euo.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Evidence on long-term oncological efficacy is available only for open radical prostatectomy but remains scarce for robot-assisted radical prostatectomy (RARP). OBJECTIVE To validate the long-term survival rates after RARP and provide stratified outcomes based on contemporary prostate cancer (PCa) risk-stratification tools. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of the European Association of Urology (EAU) Robotic Urology Section Scientific Working Group international multicenter database for RARP was performed. Patients who underwent RARP at seven pioneer robotic urology programs in Europe and the USA between 2002 and 2012 were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcomes were PCa-specific mortality and all-cause mortality. The probability of cancer-specific survival (CSS) was estimated with the competing risks method, and the probability of overall survival (OS) was estimated with the Kaplan-Meier method. RESULTS AND LIMITATIONS A total of 9876 patients who underwent RARP between 2002 and 2012 were included. Within follow-up, 1071 deaths occurred and 159 were due to PCa. At 15 yr of follow-up, CSS and OS were 97.6% (97.2%, 98.0%) and 85.5% (84.6%, 86.4%), respectively. Stratified analyses based on EAU risk groups at diagnosis and pT stage showed favorable survival rates, with low-risk (n = 4601, 46.6%), intermediate-risk (n = 4056, 41.1%), and high-risk (n = 1219, 12.3%) patients demonstrating CSS rates of 99%, 98%, and 90% at 15 yr, respectively. Notably, patients with pT3a disease had similar survival outcomes to those with pT2 disease, with worse CSS in patients with pT3b PCa (98.9% vs 97.4% vs 86.5%). Multivariable analyses identified age, prostate-specific antigen, biopsy Gleason grade group, clinical T stage, and treatment year as independent predictors of worse oncological outcomes. CONCLUSIONS Our multicenter study with long-term follow-up confirms favorable survival outcomes after RARP for localized PCa. Patients with low- and intermediate-risk disease face a higher risk of mortality from causes other than PCa. On the contrary, high-risk patients have a significantly higher risk of PCa-specific mortality. PATIENT SUMMARY In the present study, we reported the outcomes of patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy between 10 and 20 yr ago, and we found a very low probability of dying from PCa in patients with low- and intermediate-risk PCa.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, University of Foggia, Foggia, Italy.
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Pellegrino
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Martini
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, Orlando, FL, USA; University of Central Florida (UCF), Orlando, FL, USA
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Joshua Tran
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Yasmin Heiniger
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Robin Schaffar
- Department of Urology, Clinique Générale Beaulieu, Geneva, Switzerland
| | | | | | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Thomas E Ahlering
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Orlando, FL, USA; University of Central Florida (UCF), Orlando, FL, USA
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Leslie S, Jackson S, Broe M, van Diepen DC, Stanislaus C, Steffens D, McClintock G, Kim S, Jeffery N, Fallot J, Ahmadi N, Vasilaras A, Sved P, Chan L, Thanigasalam R. Improved early and late continence following robot-assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling). BJUI COMPASS 2023; 4:597-604. [PMID: 37636210 PMCID: PMC10447214 DOI: 10.1002/bco2.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To describe a novel RoboSling technique performed at the time of robot-assisted radical prostatectomy (RARP) and its utility for enhancing urinary function recovery postoperatively. Materials and Methods The surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra-vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V-Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)-urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes. Results The two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p = 0.005) and continence rates, defined as EPIC score ≥ 85 (p = 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p = 0.029). The RoboSling technique added on average 16 min to OT. Conclusions The RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. This improvement in continence outcomes was maintained long term.
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Affiliation(s)
- Scott Leslie
- RPA Institute of Academic Surgery (IAS)Royal Prince Alfred HospitalCamperdownNew South WalesAustralia
- Department of UrologyRoyal Prince Alfred Hospital (RPAH)CamperdownNew South WalesAustralia
- The University of SydneyCamperdownNew South WalesAustralia
- Chris O'Brien Lifehouse (COBL)CamperdownNew South WalesAustralia
| | - Stuart Jackson
- Department of UrologyRoyal Prince Alfred Hospital (RPAH)CamperdownNew South WalesAustralia
| | - Mark Broe
- RPA Institute of Academic Surgery (IAS)Royal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Danielle C. van Diepen
- RPA Institute of Academic Surgery (IAS)Royal Prince Alfred HospitalCamperdownNew South WalesAustralia
- Department of UrologyConcord Repatriation General HospitalConcordNew South WalesAustralia
| | - Christina Stanislaus
- RPA Institute of Academic Surgery (IAS)Royal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe)CamperdownNew South WalesAustralia
| | - George McClintock
- Department of UrologyRoyal Prince Alfred Hospital (RPAH)CamperdownNew South WalesAustralia
- Chris O'Brien Lifehouse (COBL)CamperdownNew South WalesAustralia
| | - Sia Kim
- RPA Institute of Academic Surgery (IAS)Royal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Nicola Jeffery
- Department of UrologyRoyal Prince Alfred Hospital (RPAH)CamperdownNew South WalesAustralia
- Chris O'Brien Lifehouse (COBL)CamperdownNew South WalesAustralia
| | - Jeremy Fallot
- RPA Institute of Academic Surgery (IAS)Royal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Nariman Ahmadi
- Chris O'Brien Lifehouse (COBL)CamperdownNew South WalesAustralia
| | - Arthur Vasilaras
- Department of UrologyRoyal Prince Alfred Hospital (RPAH)CamperdownNew South WalesAustralia
| | - Paul Sved
- Department of UrologyRoyal Prince Alfred Hospital (RPAH)CamperdownNew South WalesAustralia
- The University of SydneyCamperdownNew South WalesAustralia
| | - Lewis Chan
- The University of SydneyCamperdownNew South WalesAustralia
- Department of UrologyConcord Repatriation General HospitalConcordNew South WalesAustralia
| | - Ruban Thanigasalam
- RPA Institute of Academic Surgery (IAS)Royal Prince Alfred HospitalCamperdownNew South WalesAustralia
- The University of SydneyCamperdownNew South WalesAustralia
- Chris O'Brien Lifehouse (COBL)CamperdownNew South WalesAustralia
- Department of UrologyConcord Repatriation General HospitalConcordNew South WalesAustralia
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Haeuser L, Tully KH, Reicherz A, Berg S, Moritz R, Roghmann F, Noldus J, Palisaar RJ. Functional outcome after radical prostatectomy in 1313 patients: A single-center study. Prostate 2023; 83:1290-1297. [PMID: 37350456 DOI: 10.1002/pros.24591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To assess the impact of urinary continence and erectile function on the quality of life in men undergoing radical prostatectomy (RP) for prostate cancer (PC), we analyzed the preoperative and 1-year postoperative outcomes of five functional domains and their influencing factors. PATIENTS AND METHODS In this prospective study, all patients undergoing open or robot-assisted RP between Febuary 2017 and March 2020 in a single academic center were included. Patient-reported outcomes were assessed pre- and 12 months postoperatively using the Expanded Prostate Index Composite (EPIC-26) survey, evaluating continence, irritative/obstructive micturition, gastrointestinal symptoms, sexuality, and overall vitality. We examined the impact of RP on sexual function and urinary continence using multivariable logistic regression models, accounting for patient and tumor characteristics. RESULTS Overall, 1313 consecutive patients gave consent for study participation and completed both surveys. The median age was 66 years (IQR: 60-70). The majority of patients (n = 601, 46%) had an intermediate risk PC. Robotic RP was performed in 71.6% and nerve-sparing technique in 81% of the cases. The median pre- versus postoperative scores were the following: urinary continence 100 (IQR: 91.8-100) versus 85.5 (64.8-100), irritative micturition 87.5 (IQR: 75-100) versus 93.8 (IQR: 87.5-100), gastrointestinal symptoms the same with 100 (IQR: 95.8-100), vitality 95 (IQR: 80-100) versus 90 (IQR: 75-100), and erectile function 65.3 (IQR: 38.8-87.5) versus 22.2 (IQR: 12.5-48.7), respectively. Age (p < 0.001), risk classification (p = 0.002), and nerve-sparing surgery (p = 0.016) were associated with good sexual function (EPIC-26 score ≥60), while only age (p = 0.001) was statistically significantly associated with good urinary continence (EPIC-26 score ≥80). CONCLUSION Non-modifiable factors such as age and PC risk classification impact urinary continence and sexual function after RP. Nevertheless, urologic surgeons should further focus on improving nerve-sparing techniques, the only modifiable variable, to reduce the surgery's negative impact on urinary continence and sexual function.
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Affiliation(s)
- Lorine Haeuser
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Karl H Tully
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Alina Reicherz
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Sebastian Berg
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Rudolf Moritz
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Joachim Noldus
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Rein-Jüri Palisaar
- Department of Urology and Neuro-Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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Mjaess G, Orecchia L, Albisinni S. New robotic platforms for prostate surgery: the future is now. Prostate Cancer Prostatic Dis 2023; 26:519-520. [PMID: 37454240 DOI: 10.1038/s41391-023-00697-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Georges Mjaess
- Department of Urology, Hôpital Unviersitaire de Bruxelles, Brussels, Belgium.
| | - Luca Orecchia
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Simone Albisinni
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
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Geretto P, Ammirati E, Falcone M, Manassero A, Agnello M, Della Corte M, Gontero P, Giammò A. Comparison Study between Artificial Urinary Sphincter and Adjustable Male Sling: A Propensity-Score-Matched Analysis. J Clin Med 2023; 12:5489. [PMID: 37685552 PMCID: PMC10487594 DOI: 10.3390/jcm12175489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
AIMS This study aimed to compare the outcomes of the AUS and an adjustable male sling (ATOMSTM). METHODS It was a retrospective observational cohort study with two arms. Propensity score matching (PSM) was performed in order to limit selection bias and, consequently, a comparison between groups in terms of functional outcomes (24 h pad test and perception of improvement questionnaires), complications (overall complications, high-grade complications, reinterventions and explantations) and device survival was performed. RESULTS 49 patients in both arms were included. The baseline characteristics were similar between the groups. The mean follow up was 43 ± 35 months. Dryness was achieved in 22 patients (44.9%) in the AUS group and 11 (22.5%) in the sling group (p = 0.03). A total of 40 patients declared themselves well improved in the sling group (81%), while 35 (71%) declared the same in the AUS group (p = 0.78). The AUS was associated with more high-grade complications, reinterventions and explantations than the ATOMSTM. Survival at 60 months was 82 ± 9% in the sling group and 67 ± 7% in the AUS group (p = 0.03). CONCLUSIONS While the AUS may be characterized by a higher dry rate, it has an increased risk of high-grade complications and reinterventions. It is proposed that the ATOMS prosthesis can be successfully used for patients who require a less invasive procedure that maintains good functional outcomes.
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Affiliation(s)
- Paolo Geretto
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy (A.M.)
| | - Enrico Ammirati
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy (A.M.)
| | - Marco Falcone
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy (A.M.)
- Urology Clinic-A.O.U. “Città della Salute e della Scienza”-Molinette Hospital, University of Turin, 10100 Turin, Italy;
| | - Alberto Manassero
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy (A.M.)
| | - Marco Agnello
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy (A.M.)
| | - Marcello Della Corte
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy (A.M.)
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
| | - Paolo Gontero
- Urology Clinic-A.O.U. “Città della Salute e della Scienza”-Molinette Hospital, University of Turin, 10100 Turin, Italy;
| | - Alessandro Giammò
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy (A.M.)
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Dhanani NH, Lyons NB, Olavarria OA, Bernardi K, Holihan JL, Shah SK, Wilson TD, Loor MM, Kao LS, Liang MK. Robotic Versus Laparoscopic Ventral Hernia Repair: Two-Year Results From a Prospective, Multicenter, Blinded Randomized Clinical Trial. Ann Surg 2023; 278:161-165. [PMID: 37203558 DOI: 10.1097/sla.0000000000005903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Report the 2-year outcomes of a multicenter randomized controlled trial comparing robotic versus laparoscopic intraperitoneal onlay mesh ventral hernia repair. BACKGROUND Ventral hernia repair is one of the most common operations performed by general surgeons. To our knowledge, no studies have been published to date comparing long-term outcomes of laparoscopic versus robotic ventral hernia repair. METHODS The trial was registered at clinicaltrials.gov (NCT03490266). Clinical outcomes included surgical site infection, surgical site occurrence, hernia occurrence, readmission, reoperation, and mortality. RESULTS A total of 175 consecutive patients were approached that were deemed eligible for elective minimally invasive ventral hernia repair. In all, 124 were randomized and 101 completed follow-up at 2 years. Two-year follow-up was completed in 54 patients (83%) in the robotic arm and 47 patients (80%) in the laparoscopic arm. No differences were seen in surgical site infection or surgical site occurrence. Hernia recurrence occurred in 2 patients (4%) receiving robotic repair versus in 6 patients (13%) receiving laparoscopic repair (relative risk: 0.3, 95% CI: 0.06-1.39; P =0.12). No patients (0%) required reoperation in the robotic arm whereas 5 patients (11%) underwent reoperation in the laparoscopic arm ( P =0.019, relative risk not calculatable due to null outcome). CONCLUSIONS Robotic ventral hernia repair demonstrated at least similar if not improved outcomes at 2 years compared with laparoscopy. There is potential benefit with robotic repair; however, additional multi-center trials and longer follow-up are needed to validate the hypothesis-generating findings of this study.
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Affiliation(s)
- Naila H Dhanani
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Nicole B Lyons
- Dewitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL
| | - Oscar A Olavarria
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Karla Bernardi
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Julie L Holihan
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Shinil K Shah
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Todd D Wilson
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Michele M Loor
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Mike K Liang
- Department of Surgery, University of Houston, HCA Kingwood, Kingwood, TX
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Ryan OK, Doogan KL, Ryan ÉJ, Donnelly M, Reynolds IS, Creavin B, Davey MG, Kelly ME, Kennelly R, Hanly A, Martin ST, Winter DC. Comparing minimally invasive surgical and open approaches to pelvic exenteration for locally advanced or recurrent pelvic malignancies - Systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1362-1373. [PMID: 37087374 DOI: 10.1016/j.ejso.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Pelvic exenteration (PE) is a complex multivisceral surgical procedure indicated for locally advanced or recurrent pelvic malignancies. It poses significant technical challenges which account for the high risk of morbidity and mortality associated with the procedure. Developments in minimally invasive surgical (MIS) approaches and enhanced peri-operative care have facilitated improved long term outcomes. However, the optimum approach to PE remains controversial. METHODS A systematic literature search was conducted in accordance with PRISMA guidelines to identify studies comparing MIS (robotic or laparoscopic) approaches for PE versus the open approach for patients with locally advanced or recurrent pelvic malignancies. The methodological quality of the included studies was assessed systematically and a meta-analysis was conducted. RESULTS 11 studies were identified, including 2009 patients, of whom 264 (13.1%) underwent MIS PE approaches. The MIS group displayed comparable R0 resections (Risk Ratio [RR] 1.02, 95% Confidence Interval [95% CI] 0.98, 1.07, p = 0.35)) and Lymph node yield (Weighted Mean Difference [WMD] 1.42, 95% CI -0.58, 3.43, p = 0.16), and although MIS had a trend towards improved towards improved survival and recurrence outcomes, this did not reach statistical significance. MIS was associated with prolonged operating times (WMD 67.93, 95% CI 4.43, 131.42, p < 0.00001) however, this correlated with less intra-operative blood loss, and a shorter length of post-operative stay (WMD -3.89, 955 CI -6.53, -1.25, p < 0.00001). Readmission rates were higher with MIS (RR 2.11, 95% CI 1.11, 4.02, p = 0.02), however, rates of pelvic abscess/sepsis were decreased (RR 0.45, 95% CI 0.21, 0.95, p = 0.04), and there was no difference in overall, major, or specific morbidity and mortality. CONCLUSION MIS approaches are a safe and feasible option for PE, with no differences in survival or recurrence outcomes compared to the open approach. MIS also reduced the length of post-operative stay and decreased blood loss, offset by increased operating time.
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Affiliation(s)
- Odhrán K Ryan
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Katie L Doogan
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Éanna J Ryan
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
| | - Mark Donnelly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Ian S Reynolds
- Department of Surgery, Royal College of Surgeons in Ireland, 123. St. Stephen's Green, Dublin 2, Ireland
| | - Ben Creavin
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Matthew G Davey
- Department of Surgery, Royal College of Surgeons in Ireland, 123. St. Stephen's Green, Dublin 2, Ireland
| | - Michael E Kelly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Rory Kennelly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ann Hanly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Seán T Martin
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Des C Winter
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College, Dublin, Dublin 4, Ireland
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Ji J, Yang Y, Chen Z, Zhang W, Jiang S, Shen X, Zhang J, Lin L, Qu M, Wang Y, Gao X. How education level affects postoperative rehabilitation and follow-up: a single-center experience. BMC Urol 2023; 23:123. [PMID: 37464331 DOI: 10.1186/s12894-023-01282-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Radical prostatectomy remains the fundamental treatment for prostate cancer, and improving patients' compliance with postoperative follow-ups is essential for improving patients' quality of life. This study investigates the effect of education levels on patients' recovery and follow-up after radical prostatectomy. METHODS Data from 1,112 patients undergoing radical prostatectomy between 2011 and 2020 were collected using medical records, and "pc-follow" systems were used to collect patients' baseline information, education level, pathological information, number of outpatient visits, the time interval between each visit, and PSA test data. RESULTS Regarding postoperative outpatient data, there was no difference in the number of outpatient visits among the different education level groups in Shanghai (P = 0.063). A significant difference was found in the interval between outpatient visits among the groups (P < 0.001). Furthermore, significant differences were detected in the number and duration of outpatient clinic visits among the education level groups in all patients (P = 0.016, P = 0.0027). By contrast, no significant difference was found in the recovery time of urinary continence between all patients and those in Shanghai, grouped according to education level (P = 0.082, P = 0.68). For all patients and patients in the Shanghai area, the number of PSA follow-ups increased gradually with an increasing level of education (P < 0.001, P = 0.0029). CONCLUSIONS Education level affected the number of postoperative clinic visits, compliance, and the number of PSA tests. However, no significant effect on the recovery of urinary continence was found. Further, clinicians must increase their focus on patients with low education levels to achieve equitable access to health services for all patients.
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Affiliation(s)
- Jin Ji
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Yuchen Yang
- Nursing Department, Naval Hospital of Eastern Theater Command, PLA, Zhoushan, China
| | - Zeyu Chen
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Wenhui Zhang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Shaoqin Jiang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xianqi Shen
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Jili Zhang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Lu Lin
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Min Qu
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Yan Wang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China.
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Ragusa A, Brassetti A, Prata F, Iannuzzi A, Callè P, Tedesco F, Cacciatore L, Esperto F, Simone G, Scarpa RM, Papalia R. Predictors of Urinary Continence Recovery after Laparoscopic-Assisted Radical Prostatectomy: Is Surgical Urethral Length the Only Key Factor? Life (Basel) 2023; 13:1550. [PMID: 37511925 PMCID: PMC10381846 DOI: 10.3390/life13071550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Several efforts in recent years have been made to predict urinary continence (UC) recovery after radical prostatectomy. The aim of our study was to investigate the impact of surgical urethral length preservation (SULP) on urinary continence after LARP (laparoscopic-assisted radical prostatectomy). We retrospectively queried our datasets from May 2021 to May 2022. After the application of exclusion criteria, a total of 100 patients who underwent LARP for prostate cancer at our institution were enrolled. Through a sterile ruler inserted by a 12 mm trocar, the length of the membranous urethra spared during LARP was assessed intra-operatively. The baseline and peri- and postoperative data of patients were collected, and UC was defined as 0 or 1 on a safety pad. The median SULP was 20.5 mm (IQR, 14.5-25), and the median intraoperative EBL were 150 mL (IQR, 100-200). The Kaplan-Meier curve showed a significant difference at 20 mm, which was used as the cut-off value for SULP (log-rank test, p < 0.001). Multivariate Cox proportional hazards models showed that SULP and EBL < 250 mL were associated with UC recovery (all p < 0.02). Surgical urethral length preservation seemed to improve early UC recovery after LARP. Further multicentric studies are needed to confirm our findings.
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Affiliation(s)
- Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Pasquale Callè
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Francesco Esperto
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
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Hjelle LV, Sælen M, Aarsæther E, Knutsen T, Andersen S, Bentzen AG, Richardsen E, Wilsgaard T, Fosså SD, Haugnes HS. The Longitudinal Course of Prospectively Recorded Patient-reported Outcomes in Prostate Cancer Patients Treated with Surgery and Salvage Radiotherapy. EUR UROL SUPPL 2023; 53:6-15. [PMID: 37441342 PMCID: PMC10334245 DOI: 10.1016/j.euros.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 07/15/2023] Open
Abstract
Background Patient-reported outcome measures (PROMs) after prostate cancer (PC) treatment, including both radical prostatectomy (RP) and salvage radiation therapy (SRT), are under-reported. Objective To investigate PROMs longitudinally from before SRT until 18 mo after SRT for men treated with contemporary treatment modalities. Design setting and participants This prospective, longitudinal cohort study included 120 men (whole cohort) treated with SRT administered with volumetric modulated arc radiotherapy from 2016 to 2021 at the University Hospital of North Norway. The whole cohort was followed from before SRT until 18 mo after SRT. A subcohort of 48 men was followed from before RP until 18 mo after SRT. Outcome measurements and statistical analysis PROMs were collected with the Expanded Prostate Cancer Index-26 (EPIC-26), covering symptoms of urinary incontinence, urinary irritative, bowel, sexual, and hormonal domains. The domain scores were inquired before RP, 3 mo after RP, before SRT, at SRT termination, and 3 and 18 mo after SRT. We used linear mixed models with repeated measurements design to assess changes in PROMs throughout the treatment period. Results and limitations The median age before SRT was 63 yr. For the whole cohort, all five domains worsened at 3 and 18 mo after SRT compared with those before SRT. The estimated mean changes from before SRT to 18 mo after SRT are as follows: urinary incontinence -13.1, urinary irritative function -10.4, bowel -16.8, sexual function -9.1, and hormonal function -20.2 (at clinically important levels for all domains but sexual). For the subcohort, the mean urinary incontinence, bowel, sexual, and hormonal functions were significantly worsened 3 and 18 mo after SRT compared with those before RP at clinically important levels. Conclusions Men treated for PC report particular increased severity of urinary, bowel, sexual, and hormonal symptoms after SRT compared with baseline status. Patient summary For men with prostate cancer, the treatment combination of surgery and salvage radiotherapy worsens urinary incontinence and bowel, sexual, and hormonal functions.
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Affiliation(s)
- Line V. Hjelle
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Marie Sælen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Erling Aarsæther
- Department of Urology, University Hospital of North Norway, Tromsø, Norway
| | - Tore Knutsen
- Department of Urology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| | - Sigve Andersen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| | - Anne G. Bentzen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Elin Richardsen
- Department of Pathology, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Institute of Community Medicine, UIT-The Artic University, Tromsø, Norway
| | - Sophie D. Fosså
- Division of Cancer Medicine and Radiotherapy, Oslo University Hospital, Oslo, Norway
| | - Hege S. Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
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de Pablos-Rodríguez P, Suárez Novo JF, Castells Esteve M, Bonet Puntí X, Picola Brau N, Abella Serra A, López Picazo E, Cabrera Coma A, Sánchez Allueva A, Vigués Julià F. Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen. Actas Urol Esp 2023; 47:288-295. [PMID: 37272321 DOI: 10.1016/j.acuroe.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To report our initial experience with robotic radical prostatectomy as an outpatient procedure. MATERIAL AND METHODS Retrospective analysis of patients who underwent RRP as MAS (Major Ambulatory Surgery) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. RESULTS We identified a total of 35 patients with an average age of 60,8 ± 6,88 years and a BMI of 27 ± 2,9 Kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ± 42,15 min and the average blood loss was 301,2 ± 184,38 mL. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, seven mild postoperative complications (Clavien I-II) and one severe complication (Clavien IIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. CONCLUSION The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients.
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Affiliation(s)
- P de Pablos-Rodríguez
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain; Escuela de Doctorado de la Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain.
| | - J F Suárez Novo
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Castells Esteve
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - X Bonet Puntí
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - N Picola Brau
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Abella Serra
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E López Picazo
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Cabrera Coma
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Sánchez Allueva
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - F Vigués Julià
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
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Sælen MG, Hjelle LV, Aarsæther E, Knutsen T, Andersen S, Bentzen AG, Richardsen E, Fosså SD, Haugnes HS. Patient-reported outcomes after curative treatment for prostate cancer with prostatectomy, primary radiotherapy or salvage radiotherapy. Acta Oncol 2023; 62:657-665. [PMID: 37353983 DOI: 10.1080/0284186x.2023.2224051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Trials reporting adverse health outcomes (AHOs) in terms of patient-reported outcome measures (PROMs) after contemporary curative treatment of prostate cancer (PC) are hampered by study heterogeneity and lack of new treatment techniques. Particularly, the evidence regarding toxicities after radiotherapy (RT) with the volumetric arc therapy (VMAT) technique is limited, and comparisons between men treated with surgery, primary radiotherapy (PRT) and salvage radiotherapy (SRT) are lacking. The aim of the study was to evaluate change in PROMs 3 months after treatment with robotic-assisted laparoscopic prostatectomy (RALP), PRT and SRT administered with VMAT. MATERIAL AND METHODS A prospective cohort study of men with PC who received curative treatment at the University Hospital of North Norway between 2012 and 2017 for RALP and between 2016 and 2021 for radiotherapy was conducted. A cohort of 787 men were included; 406 men treated with RALP, 265 received PRT and 116 received SRT. Patients completed the validated PROM instrument EPIC-26 before (pre-treatment) and 3 months after treatment. EPIC-26 domain summary scores (DSSs) were analysed, and changes from pre-treatment to 3 months reported. Changes were deemed clinically relevant if exceeding validated minimally clinically important differences (MCIDs). RESULTS Men treated with RALP reported clinically relevant declining urinary incontinence DSS (-41.7 (SD 30.7)) and sexual DSS (-46.1 (SD 30.2)). Men who received PRT reported worsened urinary irritative DSS (-5.2 (SD 19.6)), bowel DSS (-8.2 (SD 15.1)) and hormonal DSS (-9.6 (SD 18.2)). Men treated with SRT experienced worsened urinary incontinence DSS (-7.3 (SD 18.2)), urinary irritative DSS (-7.5 (SD 14.0)), bowel DSS (-12.5 (SD 16.1)), sexual DSS (-14.9 (SD 18.9)) and hormonal DSS (-23.8 (SD 20.9)). CONCLUSION AHOs 3 months after contemporary curative treatment for PC varied according to treatment modality and worsened in all treatment groups, although most in SRT.
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Affiliation(s)
- Marie G Sælen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Line V Hjelle
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Erling Aarsæther
- Department of Urology, University Hospital of North Norway, Tromsø, Norway
| | - Tore Knutsen
- Department of Urology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| | - Sigve Andersen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| | - Anne G Bentzen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Elin Richardsen
- Department of Pathology, University Hospital of North Norway, Tromsø, Norway
| | - Sophie D Fosså
- Division of Cancer Medicine and Radiotherapy, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
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Van Huele A, Van Renterghem K. Simultaneous implant of inflatable penile prosthesis and artificial urinary sphincter: a single high-volume center experience. Int J Impot Res 2023:10.1038/s41443-023-00718-0. [PMID: 37188772 DOI: 10.1038/s41443-023-00718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023]
Abstract
Erectile dysfunction and stress urinary incontinence are both an important sequel after local therapy for prostate cancer, such as radical prostatectomy and radiotherapy. The implant of an inflatable penile prosthesis or an artificial urinary sphincter is an option if other treatments fail in both cases. There is a lack of literature regarding a simultaneous dual implantation. The aim of this study is to describe per- and postoperative morbidity and functional results. We included 25 patients operated between January 2018 and August 2022. Data were collected retrospectively. Standardized questionnaires for evaluating satisfaction were administered. There was a median operative time of 45 min (IQR 41.25-58). No intra-operative complications were seen. Four patients needed revision surgery, all of them regarding the sphincter prosthesis. One of these patients had additional revision surgery due to leakage of the penile implant reservoir. There were no infectious complications. There was a median follow-up time of 29 months (IQR 9.5-43). There was a satisfaction rate of 88% with patients and 92% with partners. Postoperative pads per day were reduced to zero or one in 96% of patients. We conclude that the dual implantation of an inflatable penile prosthesis and an artificial urinary sphincter was a safe and effective treatment in our series for patients with conservative treatment-refractory stress urinary incontinence and erectile dysfunction.
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Affiliation(s)
- Andries Van Huele
- Department of Urology, Jessa Hospital, Hasselt, Belgium.
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | - Koenraad Van Renterghem
- Department of Urology, Jessa Hospital, Hasselt, Belgium
- Hasselt University, Hasselt, Belgium
- Department of Urology, University Hospital Leuven, Leuven, Belgium
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Kuklinski D, Vogel J, Henschke C, Pross C, Geissler A. Robotic-assisted surgery for prostatectomy - does the diffusion of robotic systems contribute to treatment centralization and influence patients' hospital choice? HEALTH ECONOMICS REVIEW 2023; 13:29. [PMID: 37162648 PMCID: PMC10170785 DOI: 10.1186/s13561-023-00444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Between 2008 and 2018, the share of robotic-assisted surgeries (RAS) for radical prostatectomies (RPEs) has increased from 3 to 46% in Germany. Firstly, we investigate if this diffusion of RAS has contributed to RPE treatment centralization. Secondly, we analyze if a hospital's use of an RAS system influenced patients' hospital choice. METHODS To analyze RPE treatment centralization, we use (bi-) annual hospital data from 2006 to 2018 for all German hospitals in a panel-data fixed effect model. For investigating RAS systems' influence on patients' hospital choice, we use patient level data of 4614 RPE patients treated in 2015. Employing a random utility choice model, we estimate the influence of RAS as well as specialization and quality on patients' marginal utilities and their according willingness to travel. RESULTS Despite a slight decrease in RPEs between 2006 and 2018, hospitals that invested in an RAS system could increase their case volumes significantly (+ 82% compared to hospitals that did not invest) contributing to treatment centralization. Moreover, patients are willing to travel longer for hospitals offering RAS (+ 22% than average travel time) and for specialization (+ 13% for certified prostate cancer treatment centers, + 9% for higher procedure volume). The influence of outcome quality and service quality on patients' hospital choice is insignificant or negligible. CONCLUSIONS In conclusion, centralization is partly driven by (very) high-volume hospitals' investment in RAS systems and patient preferences. While outcome quality might improve due to centralization and according specialization, evidence for a direct positive influence of RAS on RPE outcomes still is ambiguous. Patients have been voting with their feet, but research yet has to catch up.
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Affiliation(s)
- David Kuklinski
- Chair for Healthcare Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland
| | - Justus Vogel
- Chair for Healthcare Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland.
| | - Cornelia Henschke
- Department of Health Care Management, Berlin University of Technology, Berlin Centre of Health Economics Research, Strasse Des 17. Juni 135, 10623, Berlin, Germany
| | - Christoph Pross
- Department of Health Care Management, Berlin University of Technology, Strasse Des 17. Juni 135, 10623, Berlin, Germany
| | - Alexander Geissler
- Chair for Healthcare Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland
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Esperto F, Cacciatore L, Tedesco F, Testa A, Callè P, Ragusa A, Deanesi N, Minore A, Prata F, Brassetti A, Papalia R, Scarpa RM. Impact of Robotic Technologies on Prostate Cancer Patients' Choice for Radical Treatment. J Pers Med 2023; 13:jpm13050794. [PMID: 37240964 DOI: 10.3390/jpm13050794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Prostate cancer (PCa) surgery has a strong impact on men's social and sexual lives. For this reason, many patients ask for robotic surgery. To assess the rate of lost patients due to the lack of a robotic platform (RPl) at our center, we retrospectively selected 577 patients who underwent prostate biopsy between 2020 and 2021 who were eligible for radical prostatectomy (RP) (ISUP ≥ 2; age ≤ 70 yr). Patients eligible for surgery who decided to be operated received a phone call interview asking the reason for their choice. Overall, 230 patients (31.7%) underwent laparoscopic-assisted radical prostatectomy (LaRP) at our center, while 494 patients (68.3%) were not treated in our hospital. Finally, 347 patients were included: 87 patients (25.1%) underwent radiotherapy; 59 patients (17%) were already under another urologist's care; 113 patients (32.5%) underwent robotic surgery elsewhere; and 88 patients (25.4%) followed the suggestion of friends or relatives based on their surgical experience. Despite no surgical technique for RP having shown superiority in terms of oncological or functional outcomes, patients eligible for PCa treatment decided to be operated on elsewhere because of the lack of an RPl. Our results show how the presence of an RPl may increase the case volume of RP by 49% at our center.
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Antonio Testa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Pasquale Callè
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Noemi Deanesi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Antonio Minore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
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Hyun J, Ha MS, Oh SY, Tae JH, Chi BH, Chang IH, Kim TH, Myung SC, Nguyen TT, Kim JH, Kim JW, Lee YS, Lee J, Choi SY. Urinary tract infection after radiation therapy or radical prostatectomy on the prognosis of patients with prostate cancer: a population-based study. BMC Cancer 2023; 23:395. [PMID: 37138203 PMCID: PMC10157974 DOI: 10.1186/s12885-023-10869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/20/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND We aimed to assess the trends in urinary tract infections (UTIs) and prognosis of patients with prostate cancer after radical prostatectomy (RP) and radiation therapy (RT) as definitive treatment options. METHODS The data of patients diagnosed with prostate cancer between 2007 and 2016 were collected from the National Health Insurance Service database. The incidence of UTIs was evaluated in patients treated with RT, open/laparoscopic RP, and robot-assisted RP. The proportional hazard assumption test was performed using the scaled Schoenfeld residuals based on a multivariable Cox proportional hazard model. Kaplan-Meier analysis were performed to assess survival. RESULTS A total of 28,887 patients were treated with definitive treatment. In the acute phase (< 3 months), UTIs were more frequent in RP than in RT; in the chronic phase (> 12 months), UTIs were more frequent in RT than in RP. In the early follow-up period, the risk of UTIs was higher in the open/laparoscopic RP group (aHR, 1.63; 95% CI, 1.44-1.83; p < 0.001) and the robot-assisted RP group (aHR, 1.26; 95% CI, 1.11-1.43; p < 0.001), compared to the RT group. The robot-assisted RP group had a lower risk of UTIs than the open/laparoscopic RP group in the early (aHR, 0.77; 95% CI, 0.77-0.78; p < 0.001) and late (aHR, 0.90; 95% CI, 0.89-0.91; p < 0.001) follow-up periods. In patients with UTI, Charlson Comorbidity Index score, primary treatment, age at UTI diagnosis, type of UTI, hospitalization, and sepsis from UTI were risk factors for overall survival. CONCLUSIONS In patients treated with RP or RT, the incidence of UTIs was higher than that in the general population. RP posed a higher risk of UTIs than RT did in early follow-up period. Robot-assisted RP had a lower risk of UTIs than open/laparoscopic RP group in total period. UTI characteristics might be related to poor prognosis.
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Affiliation(s)
- Jihye Hyun
- Department of Applied Statistics, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, 06974, Seoul, Republic of Korea
| | - Moon Soo Ha
- Department of Urology, Hyundae General Hospital, Chung-Ang University College of Medicine, 21 Bonghyeon-ro, Gyeonggi-Do, 12013, Namyangju-si, Republic of Korea
| | - Seung Young Oh
- Department of Urology, Hyundae General Hospital, Chung-Ang University College of Medicine, 21 Bonghyeon-ro, Gyeonggi-Do, 12013, Namyangju-si, Republic of Korea
| | - Jong Hyun Tae
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-Ro, Dongjak-Gu, 06973, Seoul, Republic of Korea
| | - Byung Hoon Chi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-Ro, Dongjak-Gu, 06973, Seoul, Republic of Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-Ro, Dongjak-Gu, 06973, Seoul, Republic of Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-Ro, Dongjak-Gu, 06973, Seoul, Republic of Korea
| | - Soon Chul Myung
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-Ro, Dongjak-Gu, 06973, Seoul, Republic of Korea
| | - Tuan Thanh Nguyen
- Department of Urology, Cho Ray Hospital, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Jung Hoon Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110, Deokan-ro, Gyeonggi-Do, 14353, Gwangmyeong-si, Republic of Korea
| | - Jin Wook Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110, Deokan-ro, Gyeonggi-Do, 14353, Gwangmyeong-si, Republic of Korea
| | - Yong Seong Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110, Deokan-ro, Gyeonggi-Do, 14353, Gwangmyeong-si, Republic of Korea
| | - Jooyoung Lee
- Department of Applied Statistics, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, 06974, Seoul, Republic of Korea.
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-Ro, Dongjak-Gu, 06973, Seoul, Republic of Korea.
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Ma J, Xu W, Chen R, Zhu Y, Wang Y, Cao W, Ju G, Ren J, Ye X, He Q, Chang Y, Ren S. Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer: the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies. Int J Surg 2023; 109:1350-1359. [PMID: 37070788 PMCID: PMC10389430 DOI: 10.1097/js9.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/30/2022] [Indexed: 04/19/2023]
Abstract
BACKGROUND Due to the lack of sufficient evidence, it is not clear whether robotic-assisted radical prostatectomy (RARP) or laparoscopic radical prostatectomy (LRP) is better for prostate cancer. The authors conducted this study by separately pooling and analysing randomised controlled trials (RCTs) and non-randomised studies to compare the perioperative, functional, and oncologic outcomes between RARP and LRP. METHODS A systematic literature search was performed in March 2022 using Cochrane Library, Pubmed, Embase, Medline, Web of Science, and China National Knowledge Infrastructure. Two independent reviewers performed literature screening, data extraction and quality assessment according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Subgroup analysis and sensitivity analysis were performed. RESULTS A total of 46 articles were included, including 4 from 3 RCTs and 42 from non-randomised studies. For RCTs, meta-analysis showed that RARP and LRP were similar in blood loss, catheter indwelling time, overall complication rate, overall positive surgical margin and biochemical recurrence rates, but quantitative synthesis of non-randomised studies showed that RARP was associated with less blood loss [weighted mean difference (WMD)=-71.99, 95% CI -99.37 to -44.61, P <0.001], shorter catheterization duration (WMD=-1.03, 95% CI -1.84 to -0.22, P =0.010), shorter hospital stay (WMD=-0.41, 95% CI -0.68 to -0.13, P =0.004), lower transfusion rate (OR=0.44, 95% CI 0.35-0.56, P <0.001), lower overall complication rate (OR=0.72, 95% CI 0.54-0.96, P =0.020), and lower biochemical recurrence rate (OR=0.78, 95% CI 0.66-0.92, P =0.004), compared with LRP. Both meta-analysis of RCTs and quantitative synthesis of non-randomised studies showed that RARP was associated with improved functional outcomes. From the results of the meta-analysis of RCTs, RARP was higher than LRP in terms of overall continence recovery [odds ratio (OR)=1.60, 95% CI 1.16-2.20, P =0.004), overall erectile function recovery (OR=4.07, 95% CI 2.51-6.60, P <0.001), continence recovery at 1 month (OR=2.14, 95% CI 1.25-3.66, P =0.005), 3 (OR=1.51, 95% CI 1.12-2.02, P =0.006), 6 (OR=2.66, 95% CI 1.31-5.40, P =0.007), and 12 months (OR=3.52, 95% CI 1.36-9.13, P =0.010) postoperatively, and potency recovery at 3 (OR=4.25, 95% CI 1.67-10.82, P =0.002), 6 (OR=3.52, 95% CI 1.31-9.44, P =0.010), and 12 months (OR=3.59, 95% CI 1.78-7.27, P <0.001) postoperatively, which were consistent with the quantitative synthesis of non-randomised studies. When sensitivity analysis was performed, the results remained largely unchanged, but the heterogeneity among studies was greatly reduced. CONCLUSION This study suggests that RARP can improve functional outcomes compared with LRP. Meanwhile, RARP has potential advantages in perioperative and oncologic outcomes.
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Affiliation(s)
| | - Weidong Xu
- Department of Urology, Changzheng Hospital
| | - Rui Chen
- Department of Urology, Changhai Hospital
| | | | - Ye Wang
- Department of Urology, Changhai Hospital
| | - Wanli Cao
- Department of Urology, Changzheng Hospital
| | - Guanqun Ju
- Department of Urology, Changzheng Hospital
| | | | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Qian He
- Department of Health Statistics, Naval Medical University, Shanghai, China
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Thederan I, Pott A, Krueger A, Chandrasekar T, Tennstedt P, Knipper S, Tilki D, Heinzer H, Schulz KH, Makarova N, Zyriax BC. Feasibility, acceptability, and behavioral outcomes of a multimodal intervention for prostate cancer patients: Experience from the MARTINI lifestyle program. Prostate 2023; 83:929-935. [PMID: 37051922 DOI: 10.1002/pros.24534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Prostate cancer (PCa) is the most frequently diagnosed malignant tumor in men. The potential benefit of a healthy lifestyle contrasts sharply with the observed poor adherence to current international lifestyle guidelines. Thus, well-designed sustainable interventions of aftercare that can be translated into routine practice are highly recommended. The present pilot study aimed to evaluate the feasibility and acceptability of a multimodal lifestyle intervention program in PCa patients after radical prostatectomy (RP). METHODS In a single-arm study, carried out at the Martini-Klinik of the University Medical Center Hamburg-Eppendorf, Germany, 59 eligible men with locally advanced PCa were recruited within 3-6 months after RP and assigned to a multimodal lifestyle program. The program consisted of 10 weekly 6-7 h course days, with a focus on dietary control, physical activity (per World Cancer Research Fund recommendations) and psychological support. Primary objectives were feasibility, acceptability, completion rate, and safety. In addition, changes in lifestyle, psychological well-being, clinical and laboratory values were assessed. The study was registered in the German Clinical Trials Register (No. DRK S00015288 [MARTINI-Lifestyle-cohort] [www.germanctr.de]). RESULTS A high program acceptance was observed. Only three participants (5%) dropped out of the program prematurely. Personal feedback reflected appreciation for participation, personal gain through new knowledge and through the group experience. Without exception, all participants have taken part in follow-up examinations and no adverse events or incidents occurred. In addition, changes in lifestyle habits, clinical parameters and improved quality of life were detected. CONCLUSION The MARTINI lifestyle program appears feasible and safe, and acceptance of the multimodal intervention was high among PCa patients. These encouraging results favor conducting a large multicenter trial to implement the program into routine practice and to evaluate the effectiveness of the intervention on survival and quality of life.
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Affiliation(s)
- Imke Thederan
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Aliaksandra Pott
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Krueger
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Pierre Tennstedt
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Knipper
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Schulz
- Department of Medical Psychology, University Hospital Hamburg-Eppendorf and UKE Athleticum-Center for Athletic Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nataliya Makarova
- Midwifery science-Health Care research and Prevention, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Midwifery science-Health Care research and Prevention, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Logan CD, Mahenthiran AK, Siddiqui MR, French DD, Hudnall MT, Patel HD, Murphy AB, Halpern JA, Bentrem DJ. Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy. J Surg Oncol 2023. [PMID: 37036165 DOI: 10.1002/jso.27274] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. STUDY DESIGN The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. RESULTS Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49-0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. CONCLUSION Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.
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Affiliation(s)
- Charles D Logan
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Ashorne K Mahenthiran
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mohammad R Siddiqui
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dustin D French
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Matthew T Hudnall
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Hiten D Patel
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua A Halpern
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David J Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Bernal J, Venkatesan K, Martins FE. Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options. J Clin Med 2023; 12:jcm12072697. [PMID: 37048780 PMCID: PMC10095222 DOI: 10.3390/jcm12072697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/18/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Pelvic malignancies, including prostate, rectal, and bladder cancers, are among the most frequent malignancies found in the male population. These issues are most effectively and commonly treated with radiotherapy and/or surgery. However, these treatments can cause collateral damage, resulting in significant impacts on quality of life, with erectile dysfunction being one of the most frequent postoperative complications. Currently, there are several treatment options for erectile dysfunction, including oral phosphodiesterase type 5 inhibitors, vacuum erection devices, intracorporeal injections, and penile prosthesis. The latter has shown to be an effective and safe technique, with results comparable to those obtained by patients without pelvic surgery or radiotherapy. The results of early penile rehabilitation programs are promising and they have been incorporated into a greater proportion of treatment plans more recently, with varying degrees of success. In this narrative review, we summarize the literature on erectile dysfunction after pelvic cancer treatments and its management.
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Affiliation(s)
- Jose Bernal
- Department of Urology, Hospital Sotero del Rio/Clinica Indisa, Santiago 13123, Chile
| | - Krishnan Venkatesan
- Department of Urology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Francisco E Martins
- Department of Urology, School of Medicine, University of Lisbon, Hospital Santa Maria, 1649-035 Lisbon, Portugal
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