Reducing the Risk of Postoperative Complications After Robot-assisted Radical Prostatectomy in Prostate Cancer Patients: Results of an Audit and Feedback Intervention Following the Implementation of Prospective Data Collection

Coping strategies mediate the relationship between fear of cancer recurrence and quality of life in postoperative patients with prostate cancer: a multicentre survey

PURPOSE

The aim of the present study was to investigate the relationships between fear of cancer recurrence and quality of life in patients with prostate cancer. A model based on Lazarus' and Folkman's theory tested the specific hypothesis: fear of cancer recurrence has a direct and indirect effect on quality of life mediated by coping strategies.

METHODS

A questionnaire survey was conducted on 305 patients with prostate cancer who underwent radical surgery, including demographic information, FoP-Q-SF (Fear of Progression Questionnaire), MCMQ (The Medical Coping Modes Questionnaire), QLQ-C30 (Questionnaire for Quality of Life Assessment in patients with cancer, version 3.0), and a mediator model was tested using the PROCESS macro for SPSS.

RESULTS

The total FoP-Q-SF score of 305 postoperative prostate cancer patients was 34.3 ± 5.856, with approximately 41.6% of the patients scoring higher than 34. There were significant indirect effects of fear of cancer recurrence on global health status through face [a1b1; 0.0394, Boot CIs 0.0025, 0.0819] and yield [a3b3; -0.1075, Boots CIs - 0.1657, -0.0557] but not for evasive [a2b2; 0.0235; Boots CIs - 0.057, 0.0508].

CONCLUSIONS

Coping strategies are the most important mediating factors between fear of cancer recurrence and QOL among patients with prostate cancer. Our results support the proposed conceptual model, based on Lazarus' and Folkman's theory. Medical personnel need to develop corresponding intervention measures based on the different coping methods of patients, promote disease recovery, and improve postoperative quality of life.

The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course

BACKGROUND

Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity.

OBJECTIVE

To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures.

DESIGN, SETTING, AND PARTICIPANTS

The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α.

RESULTS AND LIMITATIONS

The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement.

CONCLUSIONS

The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing.

PATIENT SUMMARY

We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk.

Prostate-specific membrane antigen Radioguided Surgery to Detect Nodal Metastases in Primary Prostate Cancer Patients Undergoing Robot-assisted Radical Prostatectomy and Extended Pelvic Lymph Node Dissection: Results of a Planned Interim Analysis of a Prospective Phase 2 Study

BACKGROUND

Extended pelvic nodal dissection (ePLND) represents the gold standard for nodal staging in prostate cancer (PCa). Prostate-specific membrane antigen (PSMA) radioguided surgery (RGS) could identify lymph node invasion (LNI) during robot-assisted radical prostatectomy (RARP).

OBJECTIVE

To report the planned interim analyses of a phase 2 prospective study (NCT04832958) aimed at describing PSMA-RGS during RARP.

DESIGN, SETTING, AND PARTICIPANTS

A phase 2 trial aimed at enrolling 100 patients with intermediate- or high-risk cN0cM0 PCa at conventional imaging with a risk of LNI of >5% was conducted. Overall, 18 patients were enrolled between June 2021 and March 2022. Among them, 12 patients underwent PSMA-RGS and represented the study cohort.

SURGICAL PROCEDURE

All patients received ⁶⁸Ga-PSMA positron emission tomography (PET)/magnetic resonance imaging; ^99mTc-PSMA-I&S was synthesised and administered intravenously the day before surgery, followed by single-photon emission computed tomography/computed tomography. A Drop-In gamma probe was used for in vivo measurements. All positive lesions (count rate ≥2 compared with background) were excised and ePLND was performed.

MEASUREMENTS

Side effects, perioperative outcomes, and performance characteristics of robot-assisted PSMA-RGS for LNI were measured.

RESULTS AND LIMITATIONS

Overall, four (33%), six (50%), and two (17%) patients had intermediate-risk, high-risk, and locally advanced PCa. Overall, two (17%) patients had pathologic nodal uptake at PSMA PET. The median operative time, blood loss, and length of stay were 230 min, 100 ml, and 5 d, respectively. No adverse events and intraoperative complications were recorded. One patient experienced a 30-d complication (Clavien-Dindo 2; 8.3%). Overall, three (25%) patients had LNI at ePLND. At per-region analyses on 96 nodal areas, sensitivity, specificity, positive predictive value, and negative predictive value of PSMA-RGS were 63%, 99%, 83%, and 96%, respectively. On a per-patient level, sensitivity, specificity, positive predictive value, and negative predictive values of PSMA-RGS were 67%, 100%, 100%, and 90%, respectively.

CONCLUSIONS

Robot-assisted PSMA-RGS in primary staging is a safe and feasible procedure characterised by acceptable specificity but suboptimal sensitivity, missing micrometastatic nodal disease.

PATIENT SUMMARY

Prostate-specific membrane antigen radioguided robot-assisted surgery is a safe and feasible procedure for the intraoperative identification of nodal metastases in cN0cM0 prostate cancer patients undergoing robot-assisted radical prostatectomy with extended pelvic lymph node dissection. However, this approach might still miss micrometastatic nodal dissemination.