Open Radical Prostatectomy Group Research Articles

The impact of surgical technique on very early functional outcomes after radical prostatectomy.

To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001). From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.

Effects of laparoscopic radical prostatectomy on wound infection of surgery in patients with prostate cancer: Ameta-analysis.

This meta-analysis aims to comprehensively assess the impact of laparoscopic radical prostatectomy (LRP) on wound infection in patients with prostate cancer (PCa). A systematic search was conducted, from database inception to November 2023, in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) comparing LRP with open radical prostatectomy (ORP) in the treatment of PCa. Two researchers independently screened the literature, extracted data and conducted quality assessments based on pre-defined inclusion and exclusion criteria. Stata 17.0 software was employed for data analysis. Overall, 15 RCTs involving 1458 PCa patients were included. The analysis revealed the incidence of wound infection (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.16-0.51, p < 0.001) and complications (OR = 0.27, 95% CI = 0.20-0.37, p < 0.001) was significantly lower in the LRP group compared to the ORP group. This study demonstrates that LRP in PCa patients can effectively reduce the incidence of wound infections and complications, indicating significant therapeutic efficacy and justifying its broader clinical application.

Minimal residual membranous urethral length and membranous urethral length predict poor recovery from incontinence after robot-assisted radical prostatectomy and after open radical prostatectomy.

To investigate how much minimal residual membranous urethral length (mRUL) and maximal urethral length (MUL) measured on MRI preoperatively affect postoperative urinary incontinence (PUI) and recovery in robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP). The subjects were 190 and 110 patients undergoing RARP and ORP, respectively, in our institution. Patients underwent preoperative MRI for prostate cancer evaluation and completed the quality of life questionnaire of the Expanded Prostate Cancer Index Composite instrument before and 1, 3, 6, and 12 months after surgery. The parameters of mRUL and MUL were measured on MRI and analyzed along with other parameters including age, body mass index, and nerve sparing. The median mRUL and MUL were 7.81 and 14.27 mm in the RARP group and 7.15 and 13.57 mm in the ORP group, respectively. Recovery rates from PUI were similar in the two groups. Multivariate analyses showed that mRUL was a predictor of baseline continence, whereas shorter MUL was a predictor of poor recovery from PUI. Patients with both shorter mRUL and MUL had significantly worse recoveries from PUI after RARP and ORP than patients with longer mRUL and MUL. Minimal residual membranous urethral length contributes to urethral function as basal urinary continence, whereas MUL represents the potential of recovery from PUI in RARP and ORP. The MUL measured by preoperative MRI can predict poor recovery from PUI after radical prostatectomy and combined evaluation of MUL and mRUL support to anticipate poor recovery of PUI.

Latest Comprehensive Medical Resource Consumption in Robot-Assisted versus Laparoscopic and Traditional Open Radical Prostatectomy: A Nationwide Population-Based Cohort Study.

Simple SummaryFew studies have evaluated long-term medical monetary cost in patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the largest and longest follow-up study to examine medical monetary cost in patients with PC undergoing ORP, LRP, or RARP. After adjustment for confounders, the medical monetary cost in the RARP group was the least compared with that in the ORP and LRP groups.Background: Few studies have evaluated long-term medical monetary cost in patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the largest and longest follow-up study to examine medical monetary cost in patients with PC undergoing ORP, LRP, or RARP. After adjustment for confounders, the medical monetary cost in the RARP group was the least compared with that in the ORP and LRP groups. Purpose: To estimate long-term medical resource consumption among patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). Patients and Methods: Participants were men enrolled in the Taiwan Cancer Registry with localized PC diagnosis who received radical prostatectomy. After adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the number of urology outpatient clinic visits required, proportion of patients being hospitalized for urinary diseases or surgical complications, and medical reimbursement for urinary diseases or surgical complications following ORP, LRP, or RARP in the first, second, and third years. Results: No differences were observed in the median number of urology outpatient clinic visits between the three types of surgical modalities up to the second year after ORP, LRP, and RARP (median: 15, 10, and seven visits, respectively; p < 0.001), but significant differences were observed in the third year. Similarly, with RARP (10.9% versus 18.7% in ORP and 9.8% in LRP; p = 0.0014), the rate of hospitalization for urinary diseases or surgical complications decreased in the third year. Medical reimbursement for urinary diseases or surgical complications reduced after RARP compared with that for ORP and LRP, with approximately 22% reduction in the first year (p = 0.0052) and 20–40% reduction in the third year (p value = 0.0024). Conclusions: Medical resource consumption in the RARP group was less compared with those in the ORP and LRP groups.

Comparison of 1-Year Health Care Costs and Use Associated With Open vs Robotic-Assisted Radical Prostatectomy

With the current patterns of adoption and use of robotic surgery and improvement in the overall survival of patients with prostate cancer, it is important to evaluate the immediate and long-term cost implications of treatments for patients with prostate cancer. To compare health care costs and use 1 year after open radical prostatectomy (ORP) vs robotic-assisted radical prostatectomy (RARP). This retrospective cohort study used a US commercial claims database from January 1, 2013, to December 31, 2018. A total of 11 457 men aged 18 to 64 years who underwent inpatient radical prostatectomy for prostate cancer and were continuously enrolled with medical and prescription drug coverage from 180 days before to 365 days after inpatient prostatectomy were identified. An inverse probability of treatment weighting analysis was performed to examine the differences in costs and use of health care services by surgical modality. Data analysis was conducted from September 2019 to July 2020. Type of surgical procedure: ORP vs RARP. Three outcomes within 1 year after the inpatient prostatectomy were investigated: (1) total health care costs, including reimbursement paid by insurers and out of pocket by patients; (2) health care use, including inpatient readmission, emergency department, hospital outpatient, and office visits; and (3) estimated days missed from work due to health care use. Of the 11 457 patients who underwent inpatient prostatectomy, 1604 (14.0%) had ORP and 9853 (86.0%) had RARP and most patients (8467 [73.9%]) were aged 55 to 64 years. Compared with patients who underwent ORP, those who received RARP had a higher cost at the index hospitalization (mean difference, $2367; 95% CI, $1821-$2914; P < .001), but similar total cumulative costs were observed within 180 days (mean difference, $397; 95% CI, -$582 to $1375; P = .43) and 1 year after discharge (-$383; 95% CI, -$1802 to $1037; P = .60). One-year postdischarge health care use was significantly lower in the RARP compared with ORP group for mean numbers of emergency department visits (-0.09 visits; 95% CI, -0.11 to -0.07 visits; P < .001) and hospital outpatient visits (-1.5 visits; -1.63 to -1.36 visits; P < .001). The reduction in use of health care services among patients who underwent RARP translated into additional savings of $2929 (95% CI, $1600-$4257; P < .001) and approximately 1.69 fewer days (95% CI, 1.49-1.89 days; P < .001) missed from work for health care visits. Total cumulative cost in this study was similar between ORP and RARP 1 year post discharge; this finding suggests that lower postdischarge health care use after RARP may offset the higher costs during the index hospitalization.

Postoperatif Radyoterapi Sonrası Alt Üriner Sistem Semptomlarının Değerlendirilmesinde Ürodinaminin Rolü: Retrospektif Kesitsel Çalışma

Objective: The aim of this study was to evaluate lower urinary tract symptoms (LUTS) and urodynamic parameters in patients with prostate cancer who received adjuvant radiotherapy (ART) or salvage radiotherapy (SRT) following open radical prostatectomy (RP) or robot-assisted radical prostatectomy (RARP) by using urodynamic parameters. Material and Meth ods: Patients who were treated with ART or SRT following RP or RARP due to prostate cancer were included. International Consultation on Incon tinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and Inter national Prostate Symptom Score (IPSS) questionnaires were filled in for the evaluation of LUTS for each irradiated patient. Urodynamic parameters such as bladder pressure, maxi mum cystometric capacity, maximum urethral pressure, maximum urethral clo sure pressure used for diagnosis of intrinsic sphincteric deficiency (ISD), and urethral length were recorded. Results: Fifty patients had un dergone open RP, while 48 had undergone RARP. ART and SRT was applied with 55 and 43 patients, respectively.There was no significant difference between the groups in terms of IPSS and ICIQ-SF scores, urgency-related measurements and maximum cystometric capacity values. Findings in filling cystometry were not significant in comparison of both RP and radiotherapy technique (p>0.05). Maximum urethral closure pressure values were significantly higher in RARP recipients, the frequency of ISD was significantly higher in the open RP group, and ure thral length was longer in the RARP group. Conclusion: No significant differ ence was found in terms of LUTS in patients who underwent ART or SRT after RP. RARP had positive effects on functional urethral length, urethral clo sure pressures and ISD frequency, regardless of timing of radiotherapy.

Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis

IntroductionThere are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. Objectivesto compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. Materials and MethodsComparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007−2015. The UC was evaluated at 3, 6, 12, 18 and 24 months. Continence was defined and classified as follows: a) UC, no need of pads, and b) urinary incontinence (UI), use of pads.To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when p < 0,05. ResultsNerve-sparing was performed in 51,7% cases. At 24 months after surgery, 72,4% patients had UC, of which 87,7% were from the ORP group and 78,1% in the LRP group (p = 0,004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (p = 0,036). ORP patients showed a higher percentage of anastomosis stricture (p = 0,03). ConclusionsLRP, non-nerve sparing, and SRT were directly related to postoperative IU.

Postoperative membranous urethral length is the single most important surgical factor predicting recovery of postoperative urinary continence

PurposeTo analyze the potential surgical factors affecting postoperative urinary continence, including postoperative membranous urethral length (MUL), in an era where open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) coexist. MethodsConsecutive patients undergoing either ORP or RARP between April 2009 and June 2017 were included in this study. Pericatheter urethrography (PCU) was performed the day of catheter removal to confirm healing of the vesicourethral anastomosis and to measure PCU-MUL. Daily usage of incontinence pad was self-reported by the patient at each post-operative visit through a questionnaire. Univariate and multivariate analyses were performed to identify factors that influenced recovery of continence. ResultsOf the 196 patients included, 121 and 75 patients received ORP and RARP, respectively. The cumulative full continence rates (0 pad/day) at 1 year in the ORP and RARP groups were 87% and 95%, respectively. In the univariate analysis, older age, high preoperative International Prostate Symptom Score (IPSS) irritative symptom domain, ORP, poorer NVB preservation, and shorter PCU-MUL were associated with delayed recovery of full continence. In the multivariate analysis, only older age, high preoperative IPSS irritative symptom domain, and shorter PCU-MUL remained as independent factors significantly associated with delayed recovery of full continence. ConclusionsOur study highlights the importance of saving the MUL as long as possible in terms of continence recovery. This holds true for ORP even in the era of RARP and surgeons should not simply give up the prospect of early urinary continence in exchange for the patient's choice of ORP instead of RARP.

Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía

IntroductionThere are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. ObjectivesTo compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. Material and methodsComparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007-2015. The UC was evaluated at 3, 6, 12, 18 and 24months. Continence was defined and classified as follows: a)UC, no need of pads, and b)urinary incontinence (UI), use of pads.To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when P<.05. ResultsNerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). ConclusionsLRP, non-nerve sparing, and SRT were directly related to postoperative UI.

Comparative Analysis of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Regarding Lower Urinary Tract Symptoms

Purpose: This study aims to assess lower urinary tract symptoms (LUTS) after radical prostatectomy (RP) and compare longitudinally the short-time LUTS changes of three techniques: robot-assisted RP (RARP), laparoscopic RP (LRP), and open RP (ORP). Materials and Methods: We reviewed prospectively the collected longitudinal data on the International Prostate Symptom Score (IPSS) from patients who performed RP for localized prostate cancer. One-year longitudinal data (preoperatively and at postoperative 3, 6, and 12 months) on IPSS were available for 322 patients. The number of patients was 231 for RARP, 42 for LRP, and 49 for ORP. LUTS was assessed on the basis of the IPSS and the IPSS quality of life (QOL) score. Results: The IPSS and IPSS related QOL scores were significantly improved over the baseline score not for the LRP and ORP but for the RARP. For patients with moderate to severe LUTS preoperatively, the RARP group immediately improved in terms of preoperative LUTS differently from both LRP and ORP groups. Only RARP significantly improved in terms of voiding symptom composites (VSC) differently from both LRP and ORP procedures. However, none of the procedures changed in terms of storage symptom composites (SSC) longitudinally. Conclusions: The improvement of LUTS for RARP may contribute to the improvement of not only SSC but also VSC.

Impact of Robotic Surgery on Sick Leave and Return to Work in Patients Undergoing Radical Prostatectomy: An Evidence-Based Analysis.

We analyzed the current evidence regarding the impact of robot-assisted radical prostatectomy vs open radical prostatectomy on the duration of sick leave for patients undergoing prostate cancer surgery. A systematic review of the literature was performed up to March 2019 using PubMed® and Web of Science. Study selection followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) Statement. Baseline and surgical outcomes were assessed for comparison between the robot-assisted radical prostatectomy and open radical prostatectomy groups. Review Manager 5.3 software was used to perform statistical analysis. Five comparative studies were identified as eligible for analysis. Patients who underwent robot-assisted radical prostatectomy were younger (WMD -0.82; 95% CI -1.24, -0.39; p=0.0002) and had a higher educational level (OR 0.54; 95% CI 0.45, 0.65; p <0.0001). Surgical outcomes assessment revealed a positive trend in favor of robot-assisted radical prostatectomy regarding estimated blood loss (WMD -595 ml; 95% CI -1,179.79, -12.81; p=0.05). The robot-assisted radical prostatectomy group presented a shorter length of stay (WMD -1.62 days; 95% CI -2.45, -0.79; p <0.001) and sick leave (WMD -10.03 days; 95% CI -16.87, -3.20; p=0.004). Notwithstanding the low quality of the current literature, available evidence suggests that robot-assisted radical prostatectomy allows shorter sick leave and quicker return to work than open radical prostatectomy. This should be regarded as an indirect cost benefit of the procedure and considered in cost analysis studies comparing robotic surgery to open surgery. Further research in this area is warranted.

Robotic surgery in urology: facts and reality. What are the real advantages of robotic approaches for prostate cancer patients?

Despite the worldwile increasing use of robotic assistance for oncology surgery, no level 1 evidence-based benefit favoring robot-assisted radical prostatectomy (RARP) versus pure laparoscopic or open approaches has been demonstrated. We aimed to perform an update of the available evidence by evaluating most recent 2016-2017 data. Population-based and prospective nonrandomized studies and one phase III randomised trial have been recently published. Early results from the phase III trial suggested that RARP led to similar early functional and oncologic outcomes compared with open radical prostatectomy. Shorter operative time, hospital stay, and lower complications rate and blood loss were reported in RARP group compared with open radical prostatectomy group. Population-based data did not demonstrate any benefit from one approach over another in terms of functional and oncologic outcomes. Robot assistance is predictive for improved potency recovery in organ-confined tumor in one large prospective trial. Main limitations, different among studies, were lack of randomization or single operator cohorts, short-term follow-up, and absence of confounding factors analysis. Robotic assistance seems to confer better results than open radical prostatectomy procedures in terms of intra- and immediate postoperative parameters (operative time, blood loss and hospital stay). Clear advantages of one technique over another on robust functional or oncologic endpoints remain unproven.

Impact of Variations in Prostatic Apex Shape on Apical Margin Positive Rate After Radical Prostatectomy: Robot-Assisted Laparoscopic Radical Prostatectomy vs Open Radical Prostatectomy.

To evaluate the effects of prostatic apex shape variations on positive apical margin (PAM) rate after radical prostatectomy (RP) by undertaking a comparative study of robot-assisted laparoscopic radical prostatectomy (RALP) vs open radical prostatectomy (ORP). A total of 3324 cases of RP (1004 ORP and 2320 RALP) from January 2004 to March 2017 were retrospectively reviewed. All patients underwent preoperative MRI and the cohorts were stratified into four categories according to prostatic apical shape at the midsagittal plane. Between ORP and RALP groups, age, body mass index, preoperative prostate-specific antigen (PSA), biopsy and pathological Gleason score (GS), clinical and pathological stage, and prostatic apex shapes were compared. Logistic regression analyses were performed to evaluate significant predictors of PAM. Propensity adjustments were undertaken before statistical analysis to minimize the lack of randomization. ORP and RALP groups showed no significant differences in age, body mass index, PSA, biopsy and pathological GS, clinical and pathological stage, as well as prostatic apical shape variations. The ORP group showed a PAM of 17.5% that was significantly higher than 12.3% of the RALP group (p < 0.001). Both groups showed the highest PAM with apical type 3, which is the apex covering the posterior aspect of membranous urethra (ORP 33.9%, RALP 28.5%). In unadjusted data, multiple logistic regression analysis showed that prostate apical type 3 was a significant independent predictor of PAM, but other apex types were not. Prostate apical type 3 was a significant independent predictor of PAM. The RALP group showed better outcomes in terms of PAM compared with the ORP group. Preoperative MRI might be a potentially useful tool for preoperative designing of the surgical modalities.

PD43-05 PROSPECTIVE COMPARISON OF OPEN VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER: ANALYSIS OF 1806 CONSECUTIVE MEN TREATED IN A UNIVERSAL HEALTHCARE SYSTEM

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2016PD43-05 PROSPECTIVE COMPARISON OF OPEN VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER: ANALYSIS OF 1806 CONSECUTIVE MEN TREATED IN A UNIVERSAL HEALTHCARE SYSTEM Adrian Fairey, Sunita Ghosh, Niels Jacobsen, Lucas Dean, Derek Bochinski, Michael Chetner, Howard Evans, Michael Hobart, David Mador, Blair St. Martin, Keith Rourke, and Eric Estey Adrian FaireyAdrian Fairey More articles by this author , Sunita GhoshSunita Ghosh More articles by this author , Niels JacobsenNiels Jacobsen More articles by this author , Lucas DeanLucas Dean More articles by this author , Derek BochinskiDerek Bochinski More articles by this author , Michael ChetnerMichael Chetner More articles by this author , Howard EvansHoward Evans More articles by this author , Michael HobartMichael Hobart More articles by this author , David MadorDavid Mador More articles by this author , Blair St. MartinBlair St. Martin More articles by this author , Keith RourkeKeith Rourke More articles by this author , and Eric EsteyEric Estey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1783AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are limited prospective data comparing outcomes of Open Radical Prostatectomy (ORP) and Robot-Assisted Radical Prostatectomy (RARP) for clinically localized prostate cancer (CLPC). Our primary objective was to compare ORP and RARP with respect to cancer control outcomes in men treated within a universal healthcare system. METHODS A prospective analysis of data from the University of Alberta Radical Prostatectomy Database was performed. Between September 2007 and January 2013, 1,806 consecutive men underwent radical prostatectomy for CLPC. The surgeon selected the surgical approach. The primary end point was biochemical recurrence (BCR). BCR was defined as a PSA≥0.2 µg/L followed by a subsequent confirmatory value or initiation of salvage therapy. Secondary endpoints included positive surgical margin (R1) rate, 1-year urinary and erectile function preservation rate, 90-day complication rate, and 90-day return to emergency room or readmission to hospital rate. The Kaplan-Meier method and multivariable Cox regression analyses were used to analyze BCR. Statistical tests were two-sided (p<0.05). RESULTS Complete data were evaluable for 1,769 out of 1,806 patients. 333 patients underwent ORP and 1,436 patients underwent RARP. The median follow-up duration was 48 months. Baseline age (62 years vs. 61 years, p=0.07), BMI (29 kg/m2 vs. 29 kg/m2, p=0.29), and D'Amico risk stratification score (low risk: 50% vs. 45%; intermediate risk: 42% vs. 46%; high risk: 8% vs. 9%, p=0.15) were similar between the ORP and RARP groups. The 5-year freedom from BCR rate differed between the ORP and RARP groups (79% vs. 86%, log rank p=0.006). In multivariable Cox regression analysis that adjusted for surgical margin status, pathologic Gleason score, pathologic T stage, and preoperative PSA, ORP was independently associated with an increased risk of BCR (HR 1.62, 95% CI 1.21 to 2.18, p=0.001). The 1-year urinary function preservation rate (60% vs. 72%, p=0.004), 1-year erectile function preservation rate (10% vs. 17%, p=0.007), and blood transfusion rate (4% vs. 1%, p<0.001) differed between the ORP and RARP groups. There were no significant differences between groups for R1 rate (24% vs. 26%, p=0.57) 90-day complication rate (27% vs. 27%, p=0.27), return to emergency room rate (21% vs. 20%, p=0.54), or readmission to hospital rate (3% vs. 4%, p=0.15). CONCLUSIONS In men treated at a Canadian academic center within a universal healthcare system, RARP provided superior cancer control, functional preservation, and blood product transfusions rates compared to ORP. Further analyses designed to examine mechanisms of differences in cancer control and functional preservation is needed. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e994 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Adrian Fairey More articles by this author Sunita Ghosh More articles by this author Niels Jacobsen More articles by this author Lucas Dean More articles by this author Derek Bochinski More articles by this author Michael Chetner More articles by this author Howard Evans More articles by this author Michael Hobart More articles by this author David Mador More articles by this author Blair St. Martin More articles by this author Keith Rourke More articles by this author Eric Estey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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

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

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 cost analysis of radical prostatectomies: Will it ever be possible?

Radical prostatectomy is the gold standard for the surgical treatment of localized prostate cancer. Even though open radical prostatectomy (ORP) has set the standard for the past 30 years, there has been increasing widespread adoption of laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP). Despite insufficient evidence demonstrating the superiority of LRP or RALP over the gold standard (ORP), many patients choose minimally-invasive procedures based upon their perceptions of outcomes and published lay and medical literature. Although the literature has resulted in a transition away from ORP in many parts of the world, the urological community has been unable to reach a consensus on the optimal surgical management for men with localized prostate cancer. What is driving this lack of consensus? Are they the oncological outcomes, functional results or rising health care costs? Al-Shaiji and colleagues address the direct cost component in a retrospective cohort chart review of patients undergoing ORP and LRP in a Canadian teaching hospital.1 Methodology and cost calculation limitations are addressed by the authors. Findings suggest that in a Canadian health environment, there may be cost savings realized by LRP over ORP particularly as experience with this procedure expands. However, these additional anticipated savings with increasing experience with LRP in a more contemporary series would undoubtedly also be realized in the ORP group, with refinements in anesthesia, reduced transfusions and reduced length of stay (as has been reported by most centres in North America);2 these refinements would probably negate any significant net cost benefit between the 2 procedures. In addition, a cost analysis restricted to the surgical procedure and daily hospital fees fails to recognize the significant health care expenses associated within the first 30 days postoperatively. To determine the less costly of the 2 procedures, a cost-minimization analysis of the data would be required; however, an assumption of equivalent outcomes must be made. Unfortunately, functional and oncological outcome data from these 2 sets of patient data are not presented; to extrapolate the less costly procedure for a patient to select or a hospital or urologist to offer may not be appropriate. As new technology and procedures are introduced, health care administrators and the public are becoming increasingly aware of the need for fiscal accountability and improved outcomes. A new field, health technology assessment, has emerged to address these issues involving the measurement of these costs and the associated economic implications. In the past, new procedures, such as ureteroscopy and percutaneous nephrolithotripsy, were introduced without any cost analysis or randomized controlled trial demonstrating their superiority over open stone surgery. The results of such studies, if performed, may seem obvious today, but at the time, those new procedures were often painstaking and fraught with more complications than open surgery. Undoubtedly, these costly urological breakthroughs were met with skepticism. Is this going to hold true for LRP and RALP? Interest in cost analyses has accompanied concerns about rising health care costs, pressures on health care policy-makers to allocate resources, and the need for health industries and other technology advocates to demonstrate the economic benefits of their technologies. Urologists must take the lead in this evaluation and use accepted health care technology assessment methodology for cost analysis, which should be incorporated within our outcome clinical trials. This would allow us to look not only at direct costs, but indirect and illness related costs as well. The opportunity for a randomized controlled trial of ORP versus LRP or RALP may have passed, but an economic analysis associated with the outcome clinical data in a prospective comparative cohort study may provide the evidence resolving this debate once and for all. I believe Canadian urologists may be ideally positioned to perform such a study.

966 ONCOLOGIC OUTCOMES FOLLOWING ROBOTIC-ASSISTED LAPAROSCOPIC VS. OPEN RADICAL PROSTATECTOMY FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Advanced (III)1 Apr 2013966 ONCOLOGIC OUTCOMES FOLLOWING ROBOTIC-ASSISTED LAPAROSCOPIC VS. OPEN RADICAL PROSTATECTOMY FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER Chad Ritch, Daniel Barocas, Chaochen You, Alexandra May, S. Duke Herrell, Peter Clark, David Penson, Sam Chang, Michael Cookson, and Joseph Smith Chad RitchChad Ritch Nashville, TN More articles by this author , Daniel BarocasDaniel Barocas Nashville, TN More articles by this author , Chaochen YouChaochen You Nashville, TN More articles by this author , Alexandra MayAlexandra May Nashville, TN More articles by this author , S. Duke HerrellS. Duke Herrell Nashville, TN More articles by this author , Peter ClarkPeter Clark Nashville, TN More articles by this author , David PensonDavid Penson Nashville, TN More articles by this author , Sam ChangSam Chang Nashville, TN More articles by this author , Michael CooksonMichael Cookson Nashville, TN More articles by this author , and Joseph SmithJoseph Smith Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.547AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent studies suggest that surgical intervention may confer a benefit over observation for intermediate-risk (IR) and high-risk (HR) prostate cancer patients. It is unclear if this benefit differs based on surgical approach. We compared biochemical recurrence (BCR) free survival as well as predictors of BCR in IR and HR patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) vs. open radical prostatectomy (ORP). METHODS A retrospective review was performed on 1286 men with IR or HR prostate cancer (cT2b or higher, or clinical Gleason Sum (GS) ≥7, or pre-op PSA >10) who underwent either RALP or ORP between 2003 -2009. We excluded any patient who had neoadjuvant therapy, <6 months of follow-up or insufficient clinicopathological data. We compared demographic, clinical and pathologic variables between the groups. Kaplan-Meier analysis was performed to compare the 5-year BCR-free survival between groups. Multivariate models were developed to determine predictors of BCR. RESULTS A total of 631 IR and HR patients (422 RALP, 209 ORP) met inclusion criteria. Median age was 62.2 years and was similar between groups, while median follow-up was shorter for RALP compared to ORP (3.7 vs. 4.5 yrs, p<0.001). Median PSA and clinical GS were 7.5 ng/ml and 7, respectively. ORP patients had a higher median PSA (8.6 vs. 6.9 ng/ml) than RALP patients (p<0.01). ORP patients had significantly more pathological GS 8-10 tumors (38% vs. 21%, p<0.001). There was a higher proportion of seminal vesicle involvement (SVI) in the ORP group (25% vs. 15%, p<0.01). The positive margin rate was similar between groups. Overall, 176 patients (28%) experienced BCR during follow-up (108 RALP, 68 ORP). There was no significant difference in 5-year BCR-free survival between groups. Extracapsular extension, pGS, and PSM were significant independent predictors of BCR in multivariate analysis. CONCLUSIONS Among IR and HR prostate cancer patients, the oncologic outcomes are similar between RALP and ORP. Not surprisingly, adverse pathologic features are a harbinger of BCR and identify those patients in need of multimodal therapy. Future research should focus on ways to reduce clinical recurrence among these patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e396 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chad Ritch Nashville, TN More articles by this author Daniel Barocas Nashville, TN More articles by this author Chaochen You Nashville, TN More articles by this author Alexandra May Nashville, TN More articles by this author S. Duke Herrell Nashville, TN More articles by this author Peter Clark Nashville, TN More articles by this author David Penson Nashville, TN More articles by this author Sam Chang Nashville, TN More articles by this author Michael Cookson Nashville, TN More articles by this author Joseph Smith Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of Surgical Stress in Patients Undergoing Open Versus Laparoscopic Radical Prostatectomy by Measuring Perioperative Serum Cytokine Levels

We evaluated the perioperative serum levels of inflammatory cytokines in patients with prostate cancer (PCa) treated with open or laparoscopic radical prostatectomy (RP) and assessed the surgical stress based on the cytokine levels in addition to conventional clinical stress markers after surgery. One hundred sixty-five patients who received RP for clinically localized PCa were enrolled. Serum levels of interleukin (IL)-10, IL-6, tumor necrosis factor-α, IL-1β, IL-8, and IL-12p70 were quantitatively measured using a multiplex bead array at three time points (i.e., before the operation [pre-OP], immediately after the operation [post-OP], and on postoperative Day 1 [POD1]). The perioperative changes in serum stress markers, including cytokines, were compared between patients who underwent open and laparoscopic RP, and the predictors for high levels of postoperative cytokines were assessed. The median age and estimated blood loss were significantly lower in the laparoscopic RP group than in the open RP group (P=.003 and P<.01, respectively). In all patients, body temperature, white blood cell count, and serum IL-10 and IL-6 levels were significantly higher at post-OP and POD1 than at pre-OP. Patients who underwent laparoscopic RP had significantly lower levels of serum IL-10, IL-6, and IL-1β at post-OP and POD1 than those who underwent open RP. Multivariate regression analyses showed that the surgical group (open versus laparoscopic) was an independent influencing factor on the levels of serum IL-6 and IL-10 at POD1 (P=.031 and P<.004, respectively) among various clinical perioperative parameters. Several inflammatory cytokines, particularly IL-6 and IL-10, are potential surgical stress markers in patients with PCa treated with RP. Based on cytokine production, our data support the view that laparoscopic RP is less invasive than open RP.