Laparoscopic Radical Prostatectomy Group Research Articles

Clinical outcomes and costs of robotic surgery in prostate cancer: a multiinstitutional study in Korea.

BackgroundThis study compared the surgical, functional, and oncologic outcomes of robot-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and retropubic radical prostatectomy (RRP) in Korean men.MethodsThe study population included 864 patients who underwent radical prostatectomy for prostate cancer in the departments of urology of five tertiary hospitals between 2010 and 2011. RALP, LRP, and RRP perioperative, oncological, and functional outcomes as well as complications were assessed. Medical cost data were analyzed for 682 of 864 patients.ResultsNo significant differences were found among the three groups regarding the length of stay, biochemical recurrence, complications, and metastasis. The RALP group had a significantly higher rate of pelvic lymph node dissection (64.6% vs. 35.3% or 53.3%, P value <0.0001) and bilateral nerve-sparing procedures (15.7% vs. 10.0% or 8.9%, P value <0.0001) and less blood loss (median 250 mL vs. 300 mL or 700 mL, P value <0.0001) than the LRP and RRP groups. The 12-month continence recovery rate was higher in the RALP group (92.1%) than in the LRP (86.5%) and RRP (84.4%) groups (P value <0.0001). Medical costs for RALP were approximately twofold to threefold higher than those for LRP or RRP.ConclusionsOur findings suggest that surgical and functional outcomes are better with robot-assisted surgery than with laparoscopic or open surgery in terms of estimated blood loss and urinary continence; however, no differences were found among groups in terms of biochemical recurrence and the rate of complications.

Prospective longitudinal outcomes of quality of life after laparoscopic radical prostatectomy compared with retropubic radical prostatectomy

BackgroundThere have been few reports on health-related quality of life (HRQOL) after laparoscopic radical prostatectomy (LRP) in Japanese patients. The aim of this study is to assess changes in HRQOL during 36 months after LRP compared with retropubic radical prostatectomy (RRP).MethodsThe subjects were 105 consecutive patients treated with LRP between 2011 and 2012. HRQOL was evaluated using the International Prostate Symptom Score (IPSS), Medical Outcome Study 8-Items Short Form Health Survey (SF-8), and Expanded Prostate Cancer Index Composite (EPIC) at baseline and 1, 3, 6, 12 and 36 months after surgery. These results were compared with data for 107 consecutive patients treated with RRP between 2005 and 2007. The comparison between LRP and RRP was examined at every time point by Mann-Whitney U-test and chi-square test. Multiple linear regression analysis was used to identify independent factors related to the urinary domain in EPIC.ResultsThe IPSS change was similar in both groups. The LRP group had a better SF-8 mental component summary score at baseline and a better SF-8 physical component summary score at 1 month after surgery. In EPIC, urinary function and bother were worse after LRP, but improved at 12 months and did not differ significantly from those after RRP; however, these factors then worsened again at 36 months after LRP. Urinary incontinence was also worse at 36 months after LRP, compared to RRP. In patients treated with nerve-sparing surgery, urinary function and urinary incontinence were similar and good at 12 and 36 months in both groups. Bowel function and bother, and sexual function and bother were similar in both groups and showed no changes from 12 to 36 months. Age and salvage radiotherapy were independent predictors of incontinence (daily use of two or more pads) in multivariate analysis. Surgical procedure was not an independent factor for incontinence, but incontinence defined as use of one pad or more was associated with the surgical procedure.ConclusionsUrinary function and bother at 36 months were worse after LRP than after RRP. Age, salvage radiotherapy and surgical procedure were associated with urinary incontinence after 36 months.

Oncological Outcomes of High-Risk Prostate Cancer Patients between Robot-Assisted Laparoscopic Radical Prostatectomy and Laparoscopic Radical Prostatectomy in Taiwan

Objective: To compare pathological and oncological outcomes between robotic-assisted laparoscopic radical prostatectomy (RaLRP) and laparoscopic radical prostatectomy (LRP) among high-risk prostate cancer patient in a tertiary center in Taiwan. Materials and methods: From November 2003 to October 2013, 129 high-risk prostate cancer patients receiving minimally-invasive radical prostatectomy were included. The Kaplan–Meier analysis was used for measuring biochemical recurrence-free survival (BFS). Multivariate logistic regression models and Cox proportional hazards regression models were used to determine predictors of positive surgical margin and BFS. Results: Among the 129 high-risk prostate cancer patients included, 80 (62%) patients received LRP and 49 (38%) patients received RaLRP. There was no significant difference of positive surgical margin and biochemical recurrence rate between RaLRP and LRP group (P = 0.802 and 0.292). Higher pathological T stage predicted an increased likelihood of positive margins (OR = 3.44, 95% CI [1.45, 8.18], P = 0.005). Higher initial PSA level (HR = 2.88, 95% CI [1.04, 7.94], P = 0.041) and positive surgical margin (HR = 2.55, 95% CI [1.20, 5.44], P = 0.015) were poor prognostic factors for BFS. Conclusion: RaLRP can be considered among high-risk prostate cancer in Asian people with comparable oncological outcomes to LRP. Higher pathological T stage was associated with increased likelihood of positive margins, patients with higher iPSA level and positive surgical margin had worsen biochemical recurrence-free survival.

Urodynamic changes in patients with prostate cancer undergoing robotic-assisted radical prostatectomy: A comparison with laparoscopic radical prostatectomy

ObjectiveThis study investigated the urinary incontinence status and urodynamic changes of localized prostate cancer patients after laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RaRP). Materials and methodsWe enrolled 36 and 30 patients who underwent LRP and RaRP, respectively. The urinary incontinence status and videourodynamic studies (VUDS) of the LRP and RaRP groups during the first year after the surgery were compared. ResultsThe RaRP group was younger and had a smaller prostate volume, shorter operation time, less blood loss, and higher proportion of patients who received postoperative radiotherapy than the LRP group. Twenty RaRP and 26 LRP patients completed VUDS during the 1-year follow-up. Overall, reduced detrusor voiding pressure (Pdet), increased maximal urinary flow rate (Qmax), and reduced bladder outlet obstruction index (BOOI) were detected at 3, 6, and 12 months postoperatively. At 12 months, both the LRP and RaRP groups had similar significant reductions of Pdet. However, only the RaRP group had a significant increase of Qmax and significant reduction of BOOI. Overall, 56.5% of patients (26 of 46) had detrusor overactivity (DO) before the surgery. The de novo DO rate and DO remission rate were 15.2% and 19.6%, respectively, without significant difference between the LRP and RaRP groups. At 6 months, the RaRP group had a significantly lower rate of stress urinary incontinence (SUI) than the LRP group (4.5% versus 47.2%, p = 0.003). In the RaRP group, the greater degree of recovery of both stress and urgency urinary continence developed during the first 6 months postoperatively. ConclusionThe changes of VUDS at 12 months postoperatively for radical prostatectomy included reduced Pdet and BOOI, and increased Qmax. At 6 months, the RaRP group had a lower SUI rate then the LRP group. The key phase of urinary continence recovery was the first 6 months after the surgery.

Oncological outcomes of high risk prostate cancer patients between robot-assisted laparoscopic radical prostatectomy and laparoscopic radical prostatectomy in Taiwan

ObjectiveTo compare pathological and oncological outcomes between robotic-assisted laparoscopic radical prostatectomy (RaLRP) and laparoscopic radical prostatectomy (LRP) among high-risk prostate cancer patient in a tertiary center in Taiwan. Materials and methodsFrom November 2003 to October 2013, 129 high-risk prostate cancer patients receiving minimally-invasive radical prostatectomy were included. The Kaplan–Meier analysis was used for measuring biochemical recurrence-free survival (BFS). Multivariate logistic regression models and Cox proportional hazards regression models were used to determine predictors of positive surgical margin and BFS. ResultsAmong the 129 high-risk prostate cancer patients included, 80 (62%) patients received LRP and 49 (38%) patients received RaLRP. There was no significant difference of positive surgical margin and biochemical recurrence rate between RaLRP and LRP group (P = 0.802 and 0.292). Higher pathological T stage predicted an increased likelihood of positive margins (OR = 3.44, 95% CI [1.45, 8.18], P = 0.005). Higher initial PSA level (HR = 2.88, 95% CI [1.04, 7.94], P = 0.041) and positive surgical margin (HR = 2.55, 95% CI [1.20, 5.44], P = 0.015) were poor prognostic factors for BFS. ConclusionRaLRP can be considered among high-risk prostate cancer in Asian people with comparable oncological outcomes to LRP. Higher pathological T stage was associated with increased likelihood of positive margins, patients with higher iPSA level and positive surgical margin had worsen biochemical recurrence-free survival.

A comparative study of laparoscopic and robotic assisted radical prostatectomy performed by a single surgeon

ObjectiveTo present the transition from laparoscopic radical prostatectomy (LRP) to robotic-assisted laparoscopic radical prostatectomy (RALP) over 10 years in a medium volume center by a single surgeon. Materials and methodsWe retrospectively reviewed 140 prostate cancer patients who underwent LRP (100 patients) or RALP (40 patients) between May 2005 and May 2015. Preoperative parameters included age, body mass index, and serum prostate specific antigen. Operative course parameters included operative time, estimated blood loss, intraoperative blood transfusion, conversion to open surgery, hospitalization days, duration of Foley catheterization, and complications. Pathological stage, surgical margin status, biochemical recurrence (BCR) rate, and continence rate at 12 months after surgery were reviewed and compared between the LRP and RALP groups. ResultThe operative outcomes revealed significantly less blood loss (143 mL vs. 306 mL, p<0.001), shorter hospital stay (6.9 days vs. 8.7 days, p=0.006), and shorter duration of Foley catheterization (9.3 days vs. 11.3 days, p<0.001) in patients who underwent RALP. Major perioperative complications occurred in four LRP patients (4%), and none were observed in RALP patients. LRP and RALP had similar positive surgical margin rates (p=0.285) and BCR rates (p=0.88). RALP resulted in better continence recovery than LRP (55% vs. 82.5%, p=0.003). ConclusionPatients who underwent RALP had better perioperative and functional outcomes. Oncologic outcomes were similar compared to patients who underwent LRP.

Health-related quality of life after robot-assisted radical prostatectomy compared with laparoscopic radical prostatectomy

The objective of this study is to compare the quality of life (QOL) outcomes between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP). Between July 2007 and July 2013, 229 patients with localized prostate cancer underwent LRP while 105 patients with localized prostate cancer underwent RARP between December 2012 and August 2014. We evaluated their QOL using the 8-item Short-Form Health Survey (SF-8) and Expanded Prostate Cancer Index of Prostate (EPIC) questionnaires at preoperative and at postoperative 3, 6 and 12 months. In the LRP and RARP groups, over 80 and 90% of patients answered questionnaires at each follow-up time, respectively. At baseline QOL of EPIC and SF-8, there was no significant difference between LRP and RARP groups. At postoperative 3months, Physical and Mental Components of SF-8 and Urinary Summary (U), all Urinary Subscales, Sexual Function and Bowel Function of EPIC showed significantly better scores in RARP group than in LRP group. At postoperative 6 and 12months, there were no differences between LRP and RARP groups in terms of all QOL scores. RARP group showed better scores in SF-8 as well as urinary and sexual function of EPIC at postoperative-3months. These differences disappeared at postoperative 6 and 12months.

Comparison of functional outcomes between laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy: a propensity score-matched comparison study.

To compare the functional outcomes after laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RARP). Between September 2008 and January 2016, 712 patients underwent radical prostatectomy (RP; 614 LRP and 98 RARP). Recovery of incontinence was evaluated through a 24-h pad test. Urinary and erectile function was evaluated using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5. Follow-up interval was 1, 3, 6 and 12 months after the surgery. The propensity score matching was used to balance the preoperative characteristics. The recovery of incontinence was similar to the two groups at 6 and 12 months after the surgery. However, patients underwent RARP restored the continence sooner than those in the LRP group in 1 and 3 months after the surgery (P < 0.001 and 0.001). For the multivariable analysis, the type of RP procedure was a uniquely meaningful contributing factor (P = 0.001, HR = 1.925; 95% CI, 1.299-2.851). In the case of urinary function, the RARP groups showed a better IPSS score than LRP groups at the 1-, 3- and 6-month visits, respectively (P = 0.008, 0.026, 0.001), and the RARP groups early improved compared with LRP groups at the 3-month visit in the case of erectile function (P = 0.018). The RARP tended toward getting back the urinary continence earlier than the LRP. In addition, urinary and erectile function recovered more quickly in the RARP group than in the LRP group.

Comparison of outcomes in laparoscopic radical prostatectomy and open radical prostatectomy

Objective To compare outcomes of laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP) performed in our hospital. Methods A non–randomized, retrospective comparative study was performed to analysis 302 prostate cancer patients from January 2011 to June 2014. One hundred and ten patients underwent LRP and 192 underwent ORP. There were no significant differences between the LRP and ORP groups with respect to patient age, body mass index, PSA level, Gleason Score, clinical T stage and transrectal ultrasonography prostate volume (P>0.05). The operating time, estimated blood loss, catheter retaining time, hospital stay time, positive surgical margin rate and urinary control rate were compared between the 2 groups. Results The median operative time of the ORP group and the LRP group was 95 min and 120 min, the difference between groups was significant (P 0.05). Conclusions Compared with ORP, LRP has shorter hospital stay time and longer operating time. Both LRP and ORP have good outcomes in oncological control and function rehabilitation. Both of them are important procedures to treat localized prostate cancer. Key words: Prostatic neoplasms; Prostatectomy; Laparoscopes; Retrospective studies

Comparison of oncologic and functional outcomes by retropubic and laparoscopic radical prostatectomy for the treatment of localized and locally advanced prostate cancer

Objective To compare the oncologic and functional outcomes of retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized and locally advanced prostate cancer (PCa). Methods From October 2000 to December 2013, 729 PCa cases who underwent radical prostatectomy were retrospectively analyzed. Of the 729 patients, 164 cases underwent RRP while 565 cases conducted LRP. The median age in RRP and LRP groups was 69 (38–84) years and 69 (39–88) years, median follow–up time was 58 (18–153) months and 66 (19–174) months, respectively. All the cases were stratified into localized (RRP 78 cases, LRP 370 cases) and locally advanced (RRP 86, LRP 195) PCa according to pathological TNM stage. Positive surgical margins (PSM), 1– and 2–year urinary continence, potency, 5–year biochemical recurrence–free survival and 5–year cancer–specific survival were recorded and analyzed between RRP and LRP groups. Results In localized and locally advanced cases between the 2 groups (RRP versus LRP), PSM rates were 11.5% versus 13.8%, 31.4% versus 32.8%, 5–year biochemical recurrence free rates were 79.7% versus 85.6%, 46.8% versus 50.6%, and 5–year cancer–specific survival rates were 97.8% versus 98.8%, 85.3% versus 91.2%. There was no significant difference between RRP and LRP groups (P>0.05). The 1– and 2–year urinary continence rates (RRP versus LRP) in localized PCa were 87.2% versus 92.7%, 97.4% versus 96.5%, respectively (P>0.05). The 1– and 2–year urinary continence rates (RRP versus LRP) in locally advanced PCa were 76.7% versus 85.1%, 88.4% versus 90.8%, respectively (P>0.05). The difference was significantly observed regarding potency between RRP and LRP groups (42.6% versus 59.0%, P<0.05) in patients with localized PCa. Conclusions The oncological and functional outcomes between RRP and LRP are comparable both in localized and locally advanced PCa. LRP had advantage on erectile functional recovery over RRP. Key words: Prostatic neoplasms; Prostatectomy; Laparoscopes; Open surgery

Comparative study of transperitoneal laparoscopic radical prostatectomy and open radical prostatectomy

Objective To compare the clinical efficacy and safety of transperitoneal laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP) for treatment of localized prostate cancer. Methods From March 2003 to December 2014, 395 consecutive cases of radical prostatectomy were retrospectively analyzed. The patients were divided into 2 groups: LRP group with 325 cases and ORP group with 70 cases. There were no significant differences in age (P=0.364), body mass index (P=0.360), preoperative PSA level (P=0.076), preoperative Gleason score (P=0.839) and prostate volume (P=0.241) between LRP group and ORP group. Therapeutic effect was compared between the 2 groups. Results The differences of operative time (LRP: 114±29 min, ORP: 150±39 min, P=0.002), blood loss (248±96, 569±166 ml, P<0.001), intestinal function recovery time (2.2±0.9, 3.0±0.8 d, P=0.031), postoperative hospital stay (7.1±1.4, 8.9±1.6 d, P=0.028) and complication rate(P<0.001) were significantly between the 2 groups. There were no significant differences in positive surgical margin rate(P=0.397) and 1–year or 2–year biochemical recurrence rate (P=0.664, P=0.238) between the 2 groups. Conclusion In the present cohort, compared with open surgery, LRP had advantages of fewer traumas, quicker recovery and fewer complications, while the tumor control was similar. Key words: Prostatic neoplasms; Laparoscopes; Radical prostatectomy; Open surgery; Treatment outcome

Laparoscopic radical prostatectomy after previous transurethral resection of prostate using a catheter balloon inflated in prostatic urethra: Oncological and functional outcomes from a matched pair analysis.

To explore the surgical, oncological and functional outcomes of laparoscopic radical prostatectomy in patients who have undergone transurethral resection of the prostate, using a catheter balloon inflated in the prostatic urethra. A total of 25 patients were randomly assigned to the no balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy group (n = 12) and the with balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy group (n = 13). Two matched pairs analyses were carried out to identify the 12 (control A) and 13 (control B) surgery-naïve patients. The outcomes were compared between the groups with previous transurethral resection of the prostate (no balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy and with balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy groups) and the controls. The rate of intra- and postoperative complications was assessed. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the International Index of Erectile Function 5 were used for symptoms evaluation. The mean blood loss was higher in patients submitted to transurethral resection of the prostate, with statistically insignificant reduced blood loss in the with balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy group. The no balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy group had longer operative time compared with both the with balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy and control A groups (P < 0.05). International Index of Erectile Function 5 showed a significant difference between no balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy and its control group; the International Consultation on Incontinence Questionnaire showed a statistically significant difference (P < 0.05) between the no balloon previous transurethral resection of the prostate laparoscopic radical prostatectomy and control A groups. The use of a catheter balloon inflated in the prostatic urethra seems to facilitate laparoscopic radical prostatectomy in patients with previous transurethral resection of the prostate, ultimately reducing the rate of perioperative complications. These findings warrant further investigation on a larger case series with a longer follow up.

Lower urinary tract symptoms of prostate cancer patients undergoing treatments over eight-month follow-up.

To examine the changes in lower urinary tract symptoms after open radical prostatectomy, laparoscopic radical prostatectomy and brachytherapy and to determine which treatment resulted in improved lower urinary tract symptoms at 8 months follow-up. Lower urinary tract symptoms are a primary side effect after prostate cancer treatment. A time-series survey design with descriptive and comparative elements. A sample of 51 prostate cancer patients was recruited: open radical prostatectomy=20, laparoscopic radical prostatectomy=23 and brachytherapy=8. Data were collected at six time points: before treatment/baseline, 1 week post-treatment, 1 month post-treatment, 2 month post-treatment, 3 month post-treatment and 8 months post-treatment. The lower urinary tract symptoms were assessed using the International Prostate Symptom Score, with a higher score indicating a worse condition. One-way anova was used to predict the progress of urinary symptoms after treatments. Bootstrap re-sampling was conducted to assess the stability of the outcomes. Although there were no significant differences in the lower urinary tract symptoms among the three groups after treatments, the laparoscopic radical prostatectomy group had the lowest International Prostate Symptom Score score at baseline. Compared with the baseline symptoms for patients undergoing each treatment, there were significant improvements after 2 months in the open radical prostatectomy and brachytherapy groups, and after 3 months in the laparoscopic radical prostatectomy group. The prostate cancer patients undergoing the three treatments have similar lower urinary tract symptoms over 8-month follow-up although different lower urinary tract symptoms were presented before treatments. Results could be applied to educating and counselling prostate cancer patients regarding symptoms during recovery after surgery. It could also help patients better understand the outcomes related to the differing treatment methods.

MP62-09 LAPAROENDOSCOPIC SINGLE-SITE RADICAL PROSTATECTOMY VS CONVENTIONAL LAPAROSCOPIC RADICAL PROSTATECTOMY: A PROSPECTIVE RANDOMIZED CLINICAL TRIAL

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 2015MP62-09 LAPAROENDOSCOPIC SINGLE-SITE RADICAL PROSTATECTOMY VS CONVENTIONAL LAPAROSCOPIC RADICAL PROSTATECTOMY: A PROSPECTIVE RANDOMIZED CLINICAL TRIAL Gang Zhu, Pengjie Wu, Yaqun Zhang, Shengjie Liu, Bin Jin, Jianlong Wang, Hong Ma, Xin Chen, Yaoguang Zhang, Ben Wan, and Jianye Wang Gang ZhuGang Zhu More articles by this author , Pengjie WuPengjie Wu More articles by this author , Yaqun ZhangYaqun Zhang More articles by this author , Shengjie LiuShengjie Liu More articles by this author , Bin JinBin Jin More articles by this author , Jianlong WangJianlong Wang More articles by this author , Hong MaHong Ma More articles by this author , Xin ChenXin Chen More articles by this author , Yaoguang ZhangYaoguang Zhang More articles by this author , Ben WanBen Wan More articles by this author , and Jianye WangJianye Wang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site surgery (LESS) has been developed to improve the cosmetic results of minimally invasive surgery and decrease the morbidity risks associated with multiple trocar incisions. Our aims were to compare laparoendoscopic single-site surgery radical prostatectomy (LESS-RP) with conventional laparoscopic radical prostatectomy (LRP) and study their safety and efficacy. METHODS A prospective, randomized clinical trial (RCT) was undertaken in Beijing Hospital from Sept. 2012 to Sept. 2014. We have recruited 24 prostate cancer patients meeting the criteria of radical prostatectomy in the treatment of prostate cancer. The LESS-RP and LRP were all preformed through trans-peritoneal approach. RESULTS There were 12 cases treated with pure LESS-RP, while the other 12 patients treated with LRP. The mean operative times were 230.4¡À48.8 min and 194.9¡À57.5 min (P=0.117). The estimated blood loss was 403.3¡À416.6 ml and 287.5¡À279.7 ml (P=0.432). Clavien-Dindo II and higher complications were 5/12 (41.6%) in LESS-RP group and 2/12 (16.7%) in LRP group (P=0.15). There were only two Clavien-Dindo III complications happened in LESS-RP group: one case with prostate volume of 107.3 ml and pT3b had rectal injury and the another case had suprapubic cystostomy because of urethrovesical anastomosis leakage. The pelvis drainage time was 7.9¡À4.2 and 7.6¡À6.9 days, and the first post-operative day VAPS were 2.1¡À0.6 and 2.3¡À1.4 (p=0.599). Pathological results in LESS-RP group and LRP group were: T2aN0M0 5, 2, T2bN0M0 2, 3, T2cN0M0 3, 2, T3aN0M0 1, 3 and T3bN0M0 1, 2 respectively. Positive surgical margin rates were 2/12 in each group. The one month post-operative PSA levels were lower than 0.02 ng/ml in all cases. All patients were continent using less than one pad per day at 6 months post-operatively. CONCLUSIONS This is the first RCT study on LESS-RP suggesting LESS-RP is technically feasible and safe. The outcomes of LESS-RP are similar to LRP, but there are more complications in LESS-RP than LRP group. Prostate cancer patients with large prostate and advanced stage may be not suitable for LESS-RP. Moreover, LESS-RP is a hard work, time consuming and needs long learn curve, it is maybe not practical to apply this technique on old patients who may concern less on skin cosmesis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e783 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gang Zhu More articles by this author Pengjie Wu More articles by this author Yaqun Zhang More articles by this author Shengjie Liu More articles by this author Bin Jin More articles by this author Jianlong Wang More articles by this author Hong Ma More articles by this author Xin Chen More articles by this author Yaoguang Zhang More articles by this author Ben Wan More articles by this author Jianye Wang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of different operation methods for the treatment of localized and high risk prostate cancer

Objective To compare clinical efficacy and complications of three operation methods for treating the localized and high risk prostate cancer.Methods From July 2006 to July 2010,102 cases with localized and high risk prostate cancer were included in the study.Among them,51 cases received open radical prostatectomy (Group A).Their characters included aged (63.7±7.9),PSA (31.8±6.6) μg/L,Gleason scores (8.5±0.5).In this group,T2c stage was diagnosed in 38 cases and T3a stage in 13 cases.32 cases received laparoscopic radical prostatectomy(Group B).Their characters included aged (64.4± 8.3),PSA (29.9±5.2) μg/L,Glcason scores (8.7±0.4).In this group,T2c stage was diagnosed in 21 cases and T3a stage in 11 cases.19 cases received 125I implantation (Group C).Their characters included aged (61.4± 7.4),PSA (30.6±.5.7)μg/L,Gleason scores (8.6±0.6).T2v stage was found in 8 cases and T3a stage in 11 cases.Operation time,amount of bleeding,hospitalization time,drainage time,gastrointestinal function recovery time,medical expenses and survival and recurrence rate in 1 year,3 years,5 years were compared within those groups.Results Operation time in three group were (232.6±38.4) min,(186.3±31.4) min,(35.4±14.6) min,respectively.Amount of bleeding in three group were (413.6±132.4) ml,(273.9± 77.4) ml,(19.4±4.4) ml,respectively.Hospitalization time in three group were (20.9±3.7) d,(15.6± 2.2) d,(6.4±2.6) d respectively.Drainage time in three group were (8.3±1.8) d,(7.5±0.9) d,(3.2± 0.8) d,respectively.Gastrointestinal function recovery time in three group were (4.1 ±0.6) d,(3.2± 0.4) d,(0.4±0.1) d,respectively.Medical expenses in three group were (23±4) thousand yuan,(32±3) thousand yuan,(45t3) thousand yuan respectively.All those items exhibited the significantly statistical difference (P＜0.05).The survival and recurrence rates had no significant difference during the follow-up in three groups.Conciusions Compared to the open radical prostectomy and laparoscopic radical prostectomy,particle implantation for prostate cancer had advantages in minimally invasive,less bleeding,short operation time,fast recovery and protection for Intestinal function. Key words: Prostate cancer; Radical prostatectomy; Laparoscope; 125I

Assessment of postoperative quality of life: comparative study between laparoscopic and minimum incision endoscopic radical prostatectomies

To investigate the changes in postoperative quality of life (QOL) in patients with prostate cancer who underwent laparoscopic radical prostatectomy (LRP) or minimum incision endoscopic radical prostatectomy (MIE-RP). This study included a total of 115 Japanese patients with clinically localized prostate cancer who underwent either LRP or MIE-RP and were subsequently followed for more than 12 months. Before and 12 months after surgery, health-related QOL and disease-specific QOL were assessed using the Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) and the Expanded Prostate Index Composite (EPIC), respectively. LRP and MIE-RP were performed in 57 and 58 patients, respectively, and there were no significant differences in major clinicopathological parameters between these two groups. There were no significant differences in perioperative outcomes between the two groups except for the estimated blood loss, which was lower in the LRP group. There were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the SF-8 survey. Of the fourteen scores evaluated by the EPIC survey, postoperative scores for urinary summary, sexual summary, urinary function, urinary incontinence and sexual function were significantly worse than these preoperative scores in both LRP and MIE-RP groups, while there were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the EPIC survey. The postoperative QOL status in patients undergoing MIE-RP appeared to be equivalent to that in those undergoing LRP.

Quality of life and functional outcomes 10 years after laparoscopic radical prostatectomy

Background. Minimally invasive laparoscopic radical prostatectomy (LRP) has proven equally effective as open surgery in terms of cancer control and peroperative complication rate with less bleeding and postoperative pain. However, long-term follow-up data after LRP are scarce, especially as related to quality of life (QoL).Aim. To compare QoL and functional outcomes at least 10 years after LRP with a population-based control group matched for age and region.Methods. Follow-up data were obtained by mailed questionnaires from patients who responded anonymously to five international questionnaires (EQ-5D, QLQ-C30, QLQ-PR25, IPSS, and IIEF). We collected self-reported outcome data directly from 49 patients who underwent LRP more than 10 years ago in our centre. The results of the patients' overall QoL and urinary continence rates were compared with 918 controls matched for region and age.Results. Forty-two patients (86%) and 808 (88%) controls reported having no urinary leakage. Only 11 patients (24%) still had sexual activities 10 years after LRP, and three were without erectile dysfunction. There was no difference in four of five statements of the self-assessed QoL questionnaires between the LRP and control group. Anxiety level was higher in the LRP group (44%) than in the control group (23%).Conclusion. Patients reported high self-assessed QoL, although they also reported low sexual activity 10 years after LRP. Prevalence of urinary leakage was similar in both groups. However, anxiety was more common in LRP patients.

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma and evaluated the potential advantages of each. From January 2010 to December 2010, all 23 patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introduced the reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stage prostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serum PSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates and post-operative pain. There was a significant difference in operative time between the 2-port RP and LRP groups (286.5 ± 63.3 and 351.8 ± 72.4 min: p=0.0019, without any variation in blood loss (including urine) (945.1 ± 479.6 vs 1271.1 ± 871.8 ml: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RP group, but without significance (5.6 ± 1.8 vs 8.0 ± 5.6 days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8 mg/patient in 2-port RP and 50.0mg/patient in LRP. Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

Prostatectomie radicale ouverte versus laparoscopique : expérience d’un centre français

To compare peri-operative outcomes of open radical prostatectomy (ORP) to laparoscopic radical prostatectomy (LRP) in a single French institution. Between 1998 and 2003, 72 patients underwent ORP followed by 279 LRP between 2003 and 2010 for a clinically localized prostate cancer. Demographic, peri-operative and pathological data in the ORP and LRP groups were analyzed and compared. In the ORP group, compared to the LRP group, the following significant differences were found: patients were older (63.1 years versus 65.6), initial PSA was higher (10.2 ng/mL versus 6.7) and the proportion of T1c was higher (62.8 % versus 80.6 %). Operative blood loss (1500 mL versus 500) and length of hospitalization (9.0 days versus 6.3) were higher in the ORP group (P<0.001). Operative time was longer in the LRP group (250 min versus 160; P<0 .001). There was no significant difference regarding length of catheterization (average of 8.5 days). Anastomotic strictures were more frequent following ORP (P<0.001). Positive margins proportion in the ORP group (7.1 %) was lower than that observed in the LRP group (28.7 %) (P=0.001). Patients in the ORP group achieved early continence more frequently (P<0.01) but at 12 months postoperatively there was no significant difference. Patients in the LRP group had lower operative blood losses and a shorter length of hospitalization. However, in the ORP group, operative time was shorter and positive margins rate was lower.

A Prospective Study of Transition From Laparoscopic to Robot-assisted Radical Prostatectomy: Quality of Life Outcomes After 36-Month Follow-up

To compare quality of life (QOL) outcomes after conversion from laparoscopic radical prostatectomy (LRP) to robot-assisted radical prostatectomy (RALP) as the routine procedure for surgical treatment of localized cancer of the prostate (CaP). In November 2007, we changed the routine operative technique for localized CaP from LRP to RALP. The last 210 consecutive patients operated with LRP were compared with the first 210 consecutive patients operated with RALP. The patients were mailed University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and Short Form Health Survey (SF)-12 questionnaires at baseline and at 3, 12, and 36-month follow-up. In the LRP group, 89.0%, 93.8%, 93.8%, and 88.1% of patients answered questionnaires at baseline and at 3, 12, and 36-month follow-up. The corresponding numbers in the RALP group were 92.4%, 94.3%, 85.7%, and 76.4%. At 36-month follow-up, 87.9% and 82.6% of LRP and RALP patients, respectively, had regained baseline urinary function score (ns). At 36-month follow-up, 57.3% and 61.3% of LRP and RALP patients, respectively, had regained baseline sexual function score (ns). Nerve-sparing surgical procedures mitigated the adverse effects on sexual function in both groups. Surgical method was not associated with urinary function and sexual function at 36 months. Better urinary function was associated with better general mental health. Introduction of RALP did not result in improvement of functional outcome. There was no difference regarding urologic function/bother score or sexual function/bother score at 36-month follow-up in patients treated with LRP or RALP.