Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial

Nyberg, Maria; Hugosson, Jonas; Wiklund, Peter; Sjoberg, Daniel D.; Wilderäng, Ulrica; Carlsson, Sigrid; Carlsson, Stefan; Stranne, Johan; Steineck, Gunnar; Haglind, Eva; Bjartell, Anders

doi:10.1016/j.euo.2018.04.012

Cited by 74 publications

(51 citation statements)

References 17 publications

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“…The analyses included an overall comparison of the proportion of preoperatively potent patients after bilateral NS who achieved an IIEF‐5 score ≥18 and a comparison of the proportion of patients whose erections were hard enough for penetration, both subdivided by age groups. Although no significant differences were observed, a trend towards a slight advantage for RARP patients is visible, consistent with recent reports .…”

Section: Discussionsupporting

confidence: 92%

“…However, it is arguable if this observed difference is clinically relevant, especially as the differences were not statistically significant when continence rates were compared according to age groups. This supports the findings of the LAPPRO study, which did not observe statistically significant differences for urinary continence between ORP vs RARP .…”

Section: Discussionsupporting

confidence: 90%

“…After the 12‐month follow‐up, there were no statistically significant differences between groups for urinary continence rates. For EF, a small but statistically significant difference was seen in favour of RARP, which was confirmed at the 24‐month follow‐up (rate of erectile dysfunction: 68% vs 74% in ORP) .…”

Section: Discussionmentioning

confidence: 66%

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A comparative study of robot‐assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

et al. 2019

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ObjectiveTo compare oncological, functional and surgical outcomes of open retropubic radical prostatectomy (ORP) vs robotassisted laparoscopic radical prostatectomy (RARP). Patients and methodsWe identified 10 790 consecutive treated patients within our prospective database (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) who underwent either ORP (7007 patients) or RARP (3783). All procedures were performed by seven highly trained surgeons performing both surgical approaches regularly. Oncological (48-month biochemical recurrence [BCR] rate), functional (urinary continence, erectile function), and surgical outcomes (rate of nerve-sparing [NS] procedures, lymph node yield, surgical margin [SM] status, length of hospital stay [LOS], operation time, blood loss, transfusion rate, time to catheter removal) were assessed. Kaplan-Meier, multivariable Cox and logistic regression models were used to test for BCR and functional outcome differences. ResultsNo statistically significant difference regarding oncological outcome distinguished between ORP vs RARP. For functional outcomes, the 1-week continence rates were higher in the ORP group (25.8% vs 21.8%, P < 0.001). At 3 months, no statistically significant differences were observed. At 12 months, continence rates were modestly higher in the RARP group (90.3% vs 88.8%, P = 0.01). This effect was no longer observed after stratification for agegroups. The 12-month potency rates were similar in ORP vs RARP (80.3% vs 83.6%, P = 0.33). For surgical outcomes, there was no significant difference in the rates of NS procedures, lymph node yield, SM status, and LOS. Conversely, operation time was shorter in ORP, and blood loss, transfusion rates and time to catheter removal were significantly lower in RARP. ConclusionsBoth surgical approaches, performed in a high-volume centre by the same surgeons, achieve excellent, comparable oncological and functional outcomes. However, a modest advantage for RARP for surgical outcomes was observed, most likely attributable to its minimally invasive nature, and better teaching capabilities. Consequently, more than the surgical approach itself, the well-trained surgeon remains the most important factor to achieve satisfactory outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

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A comparative study of robot‐assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

et al. 2019

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“…In several studies, the PSMs for pT2 and pT3 were reported to be approximately 8.92% and 33%, respectively. The results for the PSMs of representative studies are summarized in Table 1 [6,[8][9][10][11][12][13][14][15][16]. According to our study, the overall PSM rate was 14% to 20.8%, specifically 5.8% in pT2 and 26.1% in pT3.…”

Section: Positive Surgical Marginmentioning

confidence: 59%

Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?

et al. 2020

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Robotic radical prostatectomy (RARP) is a standardized treatment for localized prostate cancer, which provides better functional outcomes and similar oncological outcomes compared to open approaches. Here, we share our experience of 12,000 RARPs by describing the outcomes of the procedure in terms of positive surgical margin (PSM), continence, and potency as well as by presenting our detailed surgical technique with recent modifications. On cancer control, the PSM rates were 5.8% and 26.1% in T2 and T3, respectively. On the premise of not compromising oncologic outcomes, a tailored approach to individual patients is essential. Even if an extracapsular extension is suspected, neurovascular bundle (NVB) tailoring can be applied using an anatomical landmark to preserve maximal nerve tissue with a negative margin. We developed a nomogram as a useful tool for deciding the degree of tailoring. For improvements of functional outcomes, we used athermal retrograde early release with a toggling technique, wherein the nerve dissection from the bottom helps with blood loss and allows for smooth NVB releasing. Additionally, we recently performed a new minimal apical dissection/lateral prostatic fascia preservation technique. As a result, our 1-week continence rate was 37% and the 6-week rate was 77.6%. In addition, the potency rates in our study were 69%, 82%, and 92% at 3 months, 6 months, and 1 year, respectively (preoperative Sexual Health Inventory for Men scores >21 & bilateral full nerve spared).

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“…Pelvic drain (PD) placement is commonly performed after RARP to prevent the formation of urinary cysts, pelvic hematomas and lymphoceles that would require further treatment. RARP has the same oncological outcome as ORP (5)(6)(7) and is associated with shorter operation time and length of hospital stay, less bleeding and higher rate of erectile function improvement (7)(8)(9)(10). This raises a question regarding the need for routine pelvic drainage after RARP.…”

Section: Introductionmentioning

confidence: 99%

Examination of necessity for pelvic drain placement after robot-assisted radical prostatectomy

Iwamoto

Kadono

Yaegashi

et al. 2021

Preprint

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PurposeRadical prostatectomy is the gold standard treatment for clinically localised prostate cancer. Pelvic drain (PD) placement is commonly performed after RARP to prevent the formation of urinary cysts, pelvic hematomas and lymphoceles that would require further treatment. RARP has been reported to have few perioperative complications, and the need for PD placement is not clear. This study aimed to assess the need for PD placement after robot-assisted radical prostatectomy (RARP). MethodThis retrospective uncontrolled before-after study analysed the effect of PD placement on postoperative complications in patients who underwent RARP between May 2009 and April 2018.ResultsAll patients prior to October 1, 2016 had a PD placed; those after did not. Of the 308 study patients, 231 received a PD (PD group) and 77 did not (ND group). The incidence of ileus, urinary tract infection and anastomotic leak did not differ significantly between the groups; nor did the incidence of asymptomatic and symptomatic lymphocele at 2 weeks and 1 year after surgery. Multivariate analysis showed that lymph node dissection is a predictor of asymptomatic lymphocele development two weeks after surgery.ConclusionPD placement is not necessary after RARP. Future large-scale studies are required to identify patients that would benefit from PD placement.

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Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial

Cited by 74 publications

References 17 publications

A comparative study of robot‐assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

A comparative study of robot‐assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?

Examination of necessity for pelvic drain placement after robot-assisted radical prostatectomy

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