Radical prostatectomy: initial experience with robot-assisted laparoscopic procedures at a large university hospital

TY - JOUR

T1 - Radical prostatectomy

T2 - initial experience with robot-assisted laparoscopic procedures at a large university hospital

AU - Fode, Mikkel

AU - Sønksen, Jens

AU - Jakobsen, Henrik

PY - 2014/6

Y1 - 2014/6

N2 - Objective. The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. Material and methods. Patient and tumour characteristics, surgeon, nerve sparing, surgical margins and blood loss were recorded prospectively in patients who underwent RRP or RALP between April 2008 and May 2012. Patients filled out the Danish Prostate Symptom Score (DAN-PSS) and International Index of Erectile Function 5 (IIEF-5) questionnaires before surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood loss and functional outcomes were compared between groups. Results. Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins (p = 0.96) or potency at 12 months (p = 0.7). Patients who had undergone RRP had an increased chance of reporting subjective continence at 12 months (odds ratio 2.6, p = 0.014). There was no difference in the proportion of RRP and RALP patients who underwent surgical treatment for incontinence (p = 0.57). On multivariate linear regression analysis, RALP was an independent predictor of a low perioperative blood loss (RRP:RALP ratio = 2.89, p < 0.0001). Conclusions. RALP is a safe procedure with regard to perioperative and oncological results. However, it is important to be aware that functional outcomes may be compromised in the initial phase when introducing RALP.

AB - Objective. The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. Material and methods. Patient and tumour characteristics, surgeon, nerve sparing, surgical margins and blood loss were recorded prospectively in patients who underwent RRP or RALP between April 2008 and May 2012. Patients filled out the Danish Prostate Symptom Score (DAN-PSS) and International Index of Erectile Function 5 (IIEF-5) questionnaires before surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood loss and functional outcomes were compared between groups. Results. Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins (p = 0.96) or potency at 12 months (p = 0.7). Patients who had undergone RRP had an increased chance of reporting subjective continence at 12 months (odds ratio 2.6, p = 0.014). There was no difference in the proportion of RRP and RALP patients who underwent surgical treatment for incontinence (p = 0.57). On multivariate linear regression analysis, RALP was an independent predictor of a low perioperative blood loss (RRP:RALP ratio = 2.89, p < 0.0001). Conclusions. RALP is a safe procedure with regard to perioperative and oncological results. However, it is important to be aware that functional outcomes may be compromised in the initial phase when introducing RALP.

KW - Aged

KW - Blood Loss, Surgical

KW - Cohort Studies

KW - Erectile Dysfunction

KW - Hospitals, University

KW - Humans

KW - Laparoscopy

KW - Linear Models

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Neoplasm, Residual

KW - Prostatectomy

KW - Prostatic Neoplasms

KW - Retrospective Studies

KW - Robotic Surgical Procedures

KW - Treatment Outcome

KW - Urinary Incontinence

U2 - 10.3109/21681805.2013.868514

DO - 10.3109/21681805.2013.868514

M3 - Journal article

C2 - 24341725

SN - 0036-5599

VL - 48

SP - 252

EP - 258

JO - Scandinavian Journal of Urology and Nephrology

JF - Scandinavian Journal of Urology and Nephrology

IS - 3

ER -