Comparison of Quality of Life Following Laparoscopic and Open Prostatectomy for Prostate Cancer

Hara, Isao; Kawabata, Gaku; Miyake, Hideaki; Nakamura, Ichiro; Hara, Shoji; Okada, Hiroshi; Kamidono, Sadao

doi:10.1097/01.ju.0000063961.99940.6c

Cited by 88 publications

(45 citation statements)

References 19 publications

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“…For example, of the 2861 RRPs performed in Quebec between 1988 and 1993, on average 80% were by urologists using this surgery 12 times or less annually. 30 Our results compare favourably with RARP centres of excellence (Table 8), 20,27,[31][32][33][34][35][36][37][38][39][40][41] despite initial difficulties and operating mainly on patients with intermediate-to high-risk disease. …”

Section: First Robotic Prostatectomy Program In Quebecsupporting

confidence: 62%

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Alhathal

El-Hakim

2013

CUAJ

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Background: Robotic-assisted radical prostatectomy (RARP) is being increasingly done in Canada. Despite this, the Canadian literature lacks publications on the oncologic and functional outcomes of RARP. The objective of this study is to report the longest single surgeon experience in the province of Quebec. Methods: We collected prospective data from 250 consecutive patients who underwent RARP by a single fellowship trained surgeon (AEH) from October 2006 to October 2012. Mean followup was 28 months (range: 1-72). The D'Amico risk stratification distribution was 34% in low-risk, 48% in intermediate-risk and 18% in high-risk groups. Results: The mean operation time (±SD) was 194 ± 60.6 minutes, and estimated blood loss 318 ± 179 mL. The transfusion rate was only 0.4%. All procedures were completed robotically. The mean hospital stay was 1.2 days, and 88% of patients were discharged on postoperative day 1. The mean catheterization time was 7 days (range: 6-13). There were 2% major (Clavien III-IV) and 7.2% minor (Clavien I-II) postoperative complications, and no mortalities. On final pathology, 76% of patients were organ-confined and 70% specimen-confined. Pathological Gleason sum ≥7 accounted for 86%. Return of urinary continence (0-pads) at 3, 6, 12, and 24 months was 73.3%, 83.5%, 92.3%, 96.5%, respectively. Potency rate (successful penetration with or without medication) at 6, 12, and 24 months was 49.3%, 85%, and 95.3%, respectively. Operative time and positive surgical margin (PSM) in organ-confined disease (pT2) decreased significantly after 50 cases. Seventeen patients (6.8%) had no undetectable prostate-specific antigen (PSA) at first visit (PSA <0.1 ng/mL). Of remaining 233 patients, biochemical recurrence (PSA >0.2 ng/mL) was 4.7% (11 patients), and another 3.4% (8 patients) received early salvage radiotherapy (rising PSA, but <0.2 ng/mL). No patients with undetectable PSA required salvage treatments within 6 months postoperatively. Conclusions:Our results compare favourably with high-volume RARP programs, despite mainly intermediate-to high-risk disease. Initial learning curve was estimated to be 50 cases. Fellowship training was instrumental in achieving adequate functional and oncological outcomes, while maintaining low complications rate.

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Section: First Robotic Prostatectomy Program In Quebecsupporting

confidence: 62%

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Alhathal

El-Hakim

2013

CUAJ

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“…All QoL measurements should be done at least during the first 6 months. [47] found no differences in QoL 6 months after surgery, but patient satisfaction was higher after laparoscopic surgery (2b). This study used a prostate-specific QoL questionnaire, which was under development by the EORTC.…”

Section: Prostatectomymentioning

confidence: 86%

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

et al. 2004

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Background: Measuring health-related quality of life (QoL) after surgery is essential for decision making by patients, surgeons, and payers. The aim of this consensus conference was twofold. First, it was to determine for which diseases endoscopic surgery results in better postoperative QoL than open surgery. Second, it was to recommend QoL instruments for clinical research. Methods: An expert panel selected 12 conditions in which QoL and endoscopic surgery are important. For each condition, studies comparing endoscopic and open surgery in terms of QoL were identified. The expert panel reached consensus on the relative benefits of endoscopic surgery and recommended generic and disease-specific QoL instruments for use in clinical research. Results: Randomized trials indicate that QoL improves earlier after endoscopic than open surgery for gastroesophageal reflux disease (GERD), cholecystolithiasis, colorectal cancer, inguinal hernia, obesity (gastric bypass), and uterine disorders that require hysterectomy. For spleen, prostate, malignant kidney, benign colorectal, and benign non-GERD esophageal diseases, evidence from nonrandomized trials supports the use of laparoscopic surgery. However, many studies failed to collect long-term results, used nonvalidated questionnaires, or measured QoL components only incompletely.

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“…10 The most recent series have concentrated on the results of nerve preservation following laparoscopic radical prostatectomy showing success rates comparable to open surgery. 14 In the study by Katz et al 15 patients were deliberately asked not to undertake any postoperative erectile rehabilitation and despite that a high potency preservation rate was observed. 15 As yet data on the efficacy of early postoperative erectile treatment rely on few randomised trials.…”

Section: Patients Bother For Sexual Function After Nsrpmentioning

confidence: 99%

Proerectile pharmacological prophylaxis following nerve-sparing radical prostatectomy (NSRP)

Gontero

Kirby

2004

Prostate Cancer Prostatic Dis

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Comparison of Quality of Life Following Laparoscopic and Open Prostatectomy for Prostate Cancer

Cited by 88 publications

References 19 publications

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

Proerectile pharmacological prophylaxis following nerve-sparing radical prostatectomy (NSRP)

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