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Zhu J, Lu Z, Cai X, Chen W. Impact of open and minimally invasive surgery on postoperative wound complications in patients undergoing prostate surgery: A meta-analysis. Int Wound J 2024; 21:e14367. [PMID: 37706271 PMCID: PMC10788585 DOI: 10.1111/iwj.14367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
In this article, we analysed the therapeutic efficacy of open radical prostatectomy (ORP) and minimally invasive surgery (MIS) after operation for the treatment of post-operation complications. In summary, because of the broad methodology of the available trials and the low number of trials, the data were limited. The investigators combined the results of six of the 211 original studies. We looked up 4 databases: PubMed, EMBASE, Web of Science and the Cochrane Library. A total of six publications were selected. The main result was the rate of post-operation wound complications. Secondary results were the time of operation and the duration of hospitalization. Our findings indicate that the minimal invasive operation can decrease the incidence of wound infections (OR, 0.61; 95% CI: 0.42,0.90, p = 0.01), bleeding (MD, -293.09; 95% CI: -431.48, -154.71, p < 0.0001), and length of stay in the hospital compared with open surgery (MD, -1.85; 95% CI: -3.52, -0.17, p = 0.03), but minimally invasive surgery increased patient operative time (MD, 51.45; 95% CI: 40.99, 61.92, p < 0.0001). Compared with the open operation, the microinvasive operation has the superiority in the treatment of the wound complications following the operation of radical prostatic carcinoma. But the operation time of the microinvasive operation is much longer. Furthermore, there is a certain amount of bias among the various studies, so it is important to be cautious in interpretation of the findings.
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Affiliation(s)
- Jialiang Zhu
- Department of UrologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Ziwen Lu
- Department of UrologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Xianguo Cai
- Department of UrologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Wanbo Chen
- Department of UrologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
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2
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Zheng Y, Lin SX, Wu S, Dahl DM, Blute ML, Zhong WD, Zhou X, Wu CL. Clinicopathological characteristics of localized prostate cancer in younger men aged ≤ 50 years treated with radical prostatectomy in the PSA era: A systematic review and meta-analysis. Cancer Med 2020; 9:6473-6484. [PMID: 32697048 PMCID: PMC7520296 DOI: 10.1002/cam4.3320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives With the rapid increase in younger age prostate cancer (PCa) patients, the impact of younger age on decision‐making for PCa treatment needs to be revaluated in the new era. Materials and Methods A systematic literature search was performed using PubMed, EMBASE, and Web of Science up to October 2019 to identify the eligible radical prostatectomy (RP) studies focusing on understanding the impact of age on clinicopathological features and oncological prognosis in patients with localized PCa in PSA era. Meta‐analyses were conducted using available hazard ratios (HRs) from both univariate and multivariate analyses. Results Twenty‐six studies including 391 068 patients with RP treatments from the PSA era were included. Of these studies, age of 50 years old (age50) is the most commonly used cut‐off age to separate the younger patient group (including either age < 50 or age ≤ 50) from the older patient group. In these studies, the incidence of younger patients varied between 2.6% and 16.6% with a median of 8.3%. Younger patients consistently showed more favorable clinicopathological features correlated with better BCR prognosis. Meta‐analyses showed a 1.38‐fold improved BCR survival of younger patients in multivariate analysis. Among the high‐risk PCa patients, younger age was independently associated with worse oncological outcomes in multivariate analyses. Conclusion In this study, we found younger age correlated with favorable clinicopathological characteristics and better BCR prognosis in low‐ to intermediate‐risk patients. In high‐risk group patients, younger patients often showed significantly worse oncological outcomes. Our study results suggest that age 50 could be used as a practical cut‐off age to separate younger age patients from older age PCa patients.
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Affiliation(s)
- Yu Zheng
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sharron X Lin
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shulin Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei-De Zhong
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xing Zhou
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Demirdağ Ç, Çitgez S, Öbek C. Clavien System Classification of Complications Developed following Laparoscopic Urological Operations Applied in our Clinic. SISLI ETFAL HASTANESI TIP BULTENI 2019; 53:228-239. [PMID: 32377088 PMCID: PMC7192280 DOI: 10.14744/semb.2018.98700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/28/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We analyzed the complications of laparoscopic surgery using Clavien system classification on 396 urological procedures performed at our institution between 2005-2009. METHODS A retrospective analysis was performed, focusing on complications associated with 396 laparoscopic surgeries performed between 2005 and 2009, which included radical and simple nephrectomy (n=188), partial nephrectomy (n=29), pyeloplasty (n=78), sacrocolpopexy (n=16) and radical prostatectomy (n=85). Complication data were tabulated according to the case number, procedure type, patient age, the American Society of Anesthesiologists score (ASA), Clavien classification system and annual complication rate during this study. Statistical analysis was performed with Fisher's exact and chi-square tests. RESULTS A total of 75 patients had complications during the study period. Thus, the total postoperative complication rate was 18.9%. When sub-stratified to various surgical procedures, complication rates were: laparoscopic radical and simple nephrectomy (11.1%), laparoscopic partial nephrectomy (37.9%), laparoscopic pyeloplasty (15.3%), laparoscopic sacrocolpopexy (18.7%) and laparoscopic radical prostatectomy (32.9%). When the complications were classified according to Clavien Classification System stage 1, 2, 3, 4, 5, complication rate was observed in 11.6%, 13.8%, 1.2%, 1%, and 0% of patients, respectively. A correlation was not identified between ASA score and complication rate (p=0.02). CONCLUSION The data presented here would enable us to compare our complication rates objectively with world literature.
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Affiliation(s)
- Çetin Demirdağ
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sinharib Çitgez
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Can Öbek
- Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Preisser F, Mazzone E, Nazzani S, Knipper S, Tian Z, Mandel P, Pompe R, Saad F, Montorsi F, Shariat SF, Huland H, Graefen M, Tilki D, Karakiewicz PI. Impact of Age on Perioperative Outcomes at Radical Prostatectomy: A Population-Based Study. Eur Urol Focus 2018; 6:1213-1219. [PMID: 30594487 DOI: 10.1016/j.euf.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/24/2018] [Accepted: 12/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radical prostatectomy (RP) represents one standard of care for patients with localized prostate cancer and is associated with several established postoperative complications. OBJECTIVE We tested the relationship between RP early postoperative outcomes and age within a population-based data repository. DESIGN, SETTING, AND PARTICIPANTS Within the National Inpatient Sample database (2008-2013), we identified patients who underwent robotically assisted or open RP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic regression (MLR), multivariable Poisson regression (MPR), and linear regression models were used. Cubic spline graphically depicted the relationship between age and complications. RESULTS AND LIMITATIONS Overall, 68780 patients underwent RP with a median age of 62 yr (interquartile range: 57-67 yr). In MLR models, patient age represented an independent predictor of overall [odds ratio (OR): 1.02, p<0.001], intraoperative (OR: 1.03, p<0.001), cardiac (OR: 1.03, p<0.001), miscellaneous medical (OR: 1.02, p<0.001), miscellaneous surgical (OR: 1.01, p=0.01), pulmonary (OR: 1.02, p<0.001), and vascular complications (OR: 1.05, p<0.001); blood transfusions (OR: 1.02, p<0.001); and bowel obstruction (OR: 1.02, p<0.001). In MPR models, patient age was associated with longer stay (OR: 1.001, p=0.02). Similar results were recorded after adjustment for clustering in stratified analyses (<70 vs ≥70 yr) and in the subgroup of patients that underwent robotically assisted RP. For nine out of twelve examined outcomes, a virtually direct relationship existed with increasing age, in cubic spline analyses. CONCLUSIONS Virtually all early postoperative RP complications are directly related to age. In consequence, these observations should be considered from an individual patient perspective as well as from a health management perspective. PATIENT SUMMARY RP is provided through a wide patient age spectrum. Virtually all early postoperative RP complications are directly related to age. Individual patient's age needs to be considered in treatment decision-making.
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Affiliation(s)
- Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Sophie Knipper
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Raisa Pompe
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Hartwig Huland
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, Québec, Canada
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5
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A contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries. Urol Oncol 2018; 36:341.e15-341.e22. [DOI: 10.1016/j.urolonc.2018.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/09/2018] [Accepted: 04/17/2018] [Indexed: 11/24/2022]
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6
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The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy. Urol Oncol 2018; 36:157.e7-157.e13. [DOI: 10.1016/j.urolonc.2017.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/17/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022]
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7
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Basiri A, de la Rosette JJMCH, Tabatabaei S, Woo HH, Laguna MP, Shemshaki H. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? World J Urol 2018; 36:609-621. [DOI: 10.1007/s00345-018-2174-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022] Open
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8
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Prise en charge diagnostique et thérapeutique des cancers de la prostate chez l’homme de plus de 75 ans. Presse Med 2017; 46:948-953. [DOI: 10.1016/j.lpm.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Martínez-Jabaloyas JM, Castelló-Porcar A, González-Baena AC, Cózar-Olmo JM, Miñana-López B, Gómez-Veiga F, Rodriguez-Antolín A. Influence of demographic and tumour variables on prostate cancer treatment with curative intent in Spain. Results of the 2010 national prostate cancer registry. Actas Urol Esp 2016; 40:485-91. [PMID: 27260350 DOI: 10.1016/j.acuro.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to determine which cancer and demographic criteria influence the indication for surgery (radical prostatectomy) or radiation therapy (external or brachytherapy) in the treatment of prostate cancer. MATERIAL AND METHODS An analysis of the 2714 patients of the 2010 National Prostate Cancer Registry treated with curative intent. The analysed variables were age, prostate-specific antigen (PSA), prostate volume, the number of biopsy cores, the percentage of positive cores, the stage, Gleason score, the type of pathologist, the presence of perineural invasion and the study centre. We analysed the association among these variables and the type of treatment (surgery vs. radiation therapy/brachytherapy), using a univariate analysis (Student's t test and chi-squared) and a binary multiple logistic regression. RESULTS The 48.12% of the patients (1306/2714) were treated with surgery, and 51.88% (1,408/2,714) underwent radiation therapy/brachytherapy. Differences were observed between the patients treated with prostatectomy and those treated with radiation therapy/brachytherapy (p<.05) in age (63.50±6.5 vs. 69.0±6.7), PSA (8.76±16.97 vs. 13.21±15.88), biopsied cores, percentage of positives cores (30.0±22 vs. 38.7±29), Gleason score (G6: 53.9% vs. 46.1%; G7: 45% vs. 55% G8-10: 26.6%, 73.4%), stage (localised: 50% vs. 50%; locally advanced: 14.6% vs. 85.4%), perineural invasion and hospital centre. In the multivariate analysis, the selected independent variables were age, PSA, percentage of positives cores, stage, Gleason score and hospital centre. CONCLUSION According to our study, age, tumour aggressiveness and stage and the centre where the patient will be treated affect the selection of curative treatment for prostate cancer.
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Affiliation(s)
| | - A Castelló-Porcar
- Servicio de Urología, Hospital Clínico Universitario, Valencia, España
| | | | - J M Cózar-Olmo
- Servicio de Urología, Hospital Virgen de las Nieves, Granada, España
| | - B Miñana-López
- Servicio de Urología, Hospital Morales Meseguer, Murcia, España
| | - F Gómez-Veiga
- Servicio de Urología, C.H.U.A.C., Hospital Universitario de Salamanca, Salamanca, España
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10
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Ryu JH, Kim YB, Jung TY, Kim SI, Byun SS, Kwon DD, Kim DY, Oh TH, Yoo TK, Ko WJ. Radical Prostatectomy in Korean Men Aged 75-Years or Older: Safety and Efficacy in Comparison with Patients Aged 65-69 Years. J Korean Med Sci 2016; 31:957-62. [PMID: 27247506 PMCID: PMC4853676 DOI: 10.3346/jkms.2016.31.6.957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/12/2016] [Indexed: 11/29/2022] Open
Abstract
Prostate cancer is the most common type of male cancer worldwide. Although radical prostatectomy (RP) is advised for prostate cancer in patients with a life expectancy of more than 10 years by various guidelines, most elderly men still do not undergo the procedure regardless of increasing life expectancy. This study aimed to determine whether RP is suitable for patients with prostate cancer aged 75 years or older. A retrospective study of patients who underwent RP at 6 institutions between 2005 and 2012 was conducted. Patients were divided into 2 groups at the time of surgery: 65-69 years (younger group) and 75 years or older (older group). We compared clinical characteristics, pathological results, complication rates, and recurrence-free survival between the two groups. Compared with the younger group, the older group had significantly higher preoperative serum prostate-specific antigen level, pre- and postoperative Eastern Cooperative Oncology Group (ECOG) performance status grade, hypertension prevalence, and Gleason score at biopsy and RP. However, except urinary incontinence, there were no statistically significant differences in the peri- and post-operative complications. After median follow-up periods of 36 months (younger group) and 40 months (older group), the biochemical recurrence-free survival rates were not significantly different (P = 0.581). Although the urinary incontinence rate was higher in the older group, RP was a suitable option for selected Korean men aged 75 years or older with limited complication rates and excellent outcomes similar to those for patients aged 65-69 years.
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Affiliation(s)
- Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Duk Yoon Kim
- Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Tae Hee Oh
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Woo Jin Ko
- Department of Urology, National Health Insurance Corporation Ilsan Hospital, Yonsei University College of Medicine, Goyang, Korea
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11
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Yadav R, Gupta NP, Akpo EE, Kumar A. Perioperative and continence outcomes of robotic radical prostatectomy in elderly Indian men (≥70 years): A sub-group analysis. Indian J Urol 2015; 31:229-33. [PMID: 26166967 PMCID: PMC4495498 DOI: 10.4103/0970-1591.159622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Many healthy elderly Indian men seek surgical treatment for localized prostate cancer. Quite often, radical surgery is not offered to the patients over 70 years of age due to the perception of increased side-effects and complications. We have previously reported our results of robotic radical prostatectomy in a study comprising 150 Indian patients, where almost a quarter of patients were elderly. This subgroup analysis was therefore focused on evaluating perioperative and continence outcomes in elderly men (≥70 years) with localized prostate cancer. MATERIALS AND METHODS Between April 2010 and August 2013, 153 men had robot-assisted radical prostatectomy performed by two surgeons. Of the 150 men analyzed, 39 (26%) were aged ≥70 years. All patients underwent robotic prostatectomy using a 4 arm da Vinci surgical system. Pre-operative, intraoperative and post-operative parameters were studied. Check cystogram was performed in all patients prior to catheter removal. Complications were categorized using the Clavien-Dindo classification system. Continence was defined as use of "no pad" or security liner only. All data were recorded prospectively and analyzed using SPSS version 20. RESULTS There were no significant intraoperative or perioperative complications in this group. Median blood loss during surgery was 150 mL. None of the patient required blood transfusion. There were two minor complications (5.1%) within the first 30 days of surgery: Minimal anastomotic site leak (one patient) requiring replacement and prolongation of Foley's drainage by 1 week and ileus (one patient). No patient had any cardiopulmonary or vascular complications in the post-operative period. The median duration of hospital stay was 3 days. The median duration of catheterization was 7 days. No patient had problem of bladder neck stenosis in the follow-up period. At 1 month, 3 months, 6 months and 1 year of follow-up, 66.7% (n = 26), 74.3% (n = 29), 87.9% (n = 34) and 94.8% (n = 37), respectively, were continent. CONCLUSIONS Robotic surgery is safe and feasible in a select group of elderly patients. It has acceptable and minimal perioperative complications along with good continence outcome.
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Affiliation(s)
- Rajiv Yadav
- Department of Urology, Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Delhi, NCR, India
| | - Narmada P Gupta
- Department of Urology, Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Delhi, NCR, India
| | - Emmanuel E Akpo
- Department of Urology, Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Delhi, NCR, India
| | - Anand Kumar
- Department of Urology, Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Delhi, NCR, India
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De Carlo F, Celestino F, Verri C, Masedu F, Liberati E, Di Stasi SM. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: surgical, oncological, and functional outcomes: a systematic review. Urol Int 2014; 93:373-83. [PMID: 25277444 DOI: 10.1159/000366008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/17/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Despite the wide diffusion of minimally invasive approaches, such as laparoscopic (LRP) and robot-assisted radical prostatectomy (RALP), few studies compare the results of these techniques with the retropubic radical prostatectomy (RRP) approach. The aim of this study is to compare the surgical, functional, and oncological outcomes and cost-effectiveness of RRP, LRP, and RALP. METHODS A systematic review of the literature was performed in the PubMed and Embase databases in December 2013. A 'free-text' protocol using the term 'radical prostatectomy' was applied. A total of 16,085 records were found. The authors reviewed the records to identify comparative studies to include in the review. RESULTS 44 comparative studies were identified. With regard to the perioperative outcome, LRP and RALP were more time-consuming than RRP, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates were the most optimal in the laparoscopic approaches. With regard to the functional and oncological results, RALP was found to have the best outcomes. CONCLUSION Our study confirmed the well-known perioperative advantage of minimally invasive techniques; however, available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. On the contrary, cost comparison clearly supports RRP.
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Affiliation(s)
- Francesco De Carlo
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
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13
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Magheli A, Busch J, Leva N, Schrader M, Deger S, Miller K, Lein M. Comparison of surgical technique (open vs. laparoscopic) on pathological and long term functional outcomes following radical prostatectomy. BMC Urol 2014; 14:18. [PMID: 24506815 PMCID: PMC3922887 DOI: 10.1186/1471-2490-14-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 02/04/2014] [Indexed: 02/05/2023] Open
Abstract
Background Few studies to date have directly compared outcomes of retropubic (RRP) and laparoscopic (LRP) radical prostatectomy. We investigated a single institution experience with RRP and LRP with respect to functional and pathological outcomes. Methods 168 patients who underwent RRP were compared to 171 patients who underwent LRP at our institution. Pathological and functional outcomes including postoperative urinary incontinence and erectile dysfunction (ED) of the two cohorts were examined. Results Patients had bilateral, unilateral and no nerve sparing technique performed in 83.3%, 1.8% and 14.9% of cases for RRP and 23.4%, 22.8% and 53.8% of cases for LRP, respectively (p < 0.001). Overall positive surgical margin rates were 22.2% among patients who underwent RRP compared to 26.5% of patients who underwent LRP (p = 0.435). Based upon pads/day, urinary continence postoperatively was achieved in 83.2% and 82.8% for RRP and LRP, respectively (p = 0.872). Analysis on postoperative ED was limited due to lack of information on the preoperative erectile status. However, postoperatively there were no differences with respect to ED between the two cohorts (p = 0.151). Based on ICIQ-scores, surgeons with more experience had lower rates of postoperative incontinence irrespective of surgical technique (p = 0.001 and p < 0.001 for continuous and stratified data, respectively). Conclusions RRP and LRP represent effective surgical approaches for the treatment of clinically localized prostate cancer. Pathological outcomes are excellent for both surgical techniques. Functional outcomes including postoperative urinary incontinence and ED are comparable between the cohorts. Surgeon experience is more relevant than surgical technique applied.
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Affiliation(s)
- Ahmed Magheli
- Department of Urology, Universitätsmedizin Berlin, Charité Campus Mitte and Benjamin Franklin, Berlin, Germany.
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Ramírez-Backhaus M, Rubio-Briones J, Collado A, Casanova J, Gómez-Ferrer A, Domínguez J, Ricos J, Monros J, Iborra I, Solsona E. Radical prostatectomy is a reasonable treatment for patients over 70 years of age. Actas Urol Esp 2014; 38:21-7. [PMID: 23648265 DOI: 10.1016/j.acuro.2013.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/17/2013] [Accepted: 02/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the tumor nature and oncological course of patients operated on by radical prostatectomy in three age groups. MATERIAL AND METHOD From the prospective completion of the data base of our department, we analyzed 1012 patients operated on between 1986 and December 2009. Patients with neo- or adjuvant treatment and those with pre-operative PSA over 50 were excluded. The sample was divided into three groups: younger than 60, 60 to 69 and over 70. The clinical, pathological variables, biochemical course and need for rescue treatment were analyzed. We consider biochemical relapse as when the PSA values reached values greater than 0.4 in two consecutive measurements. Rescue was defined as the need for hormone treatment or radiotherapy. We then made a comparative study, a univariate survival analysis by Kaplan and Meyer Curves and multivariate by Cox's regression. RESULTS The median follow-up was 55.1 months. Of the 1012 patients included in the study, 317 patients (31.3%) had biochemical progression and 259 (25.6%) required rescue treatment. We observed that the groups with the older age had a significantly higher PSA and higher stages than the rest. No differences were observed in the Gleason score of the surgical specimen or in the state of the surgical margins. Biochemical relapse free survival at 5 years was 72.3% (CI 66.4-78.2) in patients under 60 years, 65.3% (CI 60.6-70.0) for patients under 70 and 62.2% (CI 53.2-71.1) for patients of 70 years or older; P<.05. In the univariate study, age was a factor that was significantly associated to biochemical relapse. However, it loses interest in the multivariate study and PSA, pathological state and Gleason score regain interest. Rescue treatment free survival did not differ by age groups. CONCLUSIONS In the current study, worse biochemical evolution of patients over 70 was observed. However, this worse biochemical course was conditioned by clinically more aggressive tumors that, in our opinion, justifies the decision made in regards to the surgical approach taken with these patients.
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Abstract
BACKGROUND Quality of life (QoL) often is impacted after radical prostatectomy (RP) procedures. Although patients' QoL scores gradually improve after RP, changes in the QoL score over time after different RP procedures must be examined. OBJECTIVE The aim of this study was to compare the changes in QoL over time of prostate cancer patients who were treated with open RP (ORP) or laparoscopic RP (LRP) procedures. METHODS A longitudinal study design was used. A convenient sample of 67 prostate cancer patients was recruited after RP (ORP = 34, LRP = 33). QoL scores were assessed at 1, 3, and 6 months after RP using the University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI). RESULTS With respect to the PCI mean score between the ORP and LRP groups, there were significant differences in overall PCI and urinary function at time 1 (1 month after RP). However, a mixed-design analysis of covariance on the overall PCI of the 2 groups over time indicated that, after controlling for nerve sparing, there were significant differences in the main effects for group and time, but no interaction effect. CONCLUSION Results indicated that all patients' QoL scores improved over time. Laparoscopic RP patients' overall scores were better than ORP patients' scores, but this may be due to unmeasured preoperative differences in this nonrandom sample, and thus, these findings cannot be attributed to treatment differences alone. IMPLICATIONS FOR PRACTICE Patients' QoL after either RP surgery is likely to drop but is regained by 6 months. This information should be given to patients undergoing RP who are deciding between various RP procedures.
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Ploussard G, Albrand G, Rozet F, Lang H, Paillaud E, Mongiat-Artus P. Challenging treatment decision-making in older urologic cancer patients. World J Urol 2013; 32:299-308. [DOI: 10.1007/s00345-013-1158-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/21/2013] [Indexed: 12/27/2022] Open
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Kass-Iliyya A, Vasdev N, Soomro N, Durkan GC. Urinary function and health-related quality of life of patients after laparoscopic radical prostatectomy: two methods of assessment for 112 patients with up to six years of follow-up. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/1875974212465575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Wide variation exists between methods of assessment of urinary function following laparoscopic radical prostatectomy (LRP). Objective: To assess post-operative urinary function and quality of life (QOL) after LRP using validated questionnaires and compare these results with subjective assessments obtained during outpatient consultations. Design, setting and participants: Between January 2004 and December 2009, 200 men with organ-confined prostate cancer underwent LRP at our centre. Post-operative urinary function and QOL were evaluated using validated questionnaires (ICIQ-MLUTS and FACT-P). Data regarding urinary function, which were collected at the outpatient clinic (OPC), were also available for these 112 patients. Outcome measurements and statistical analysis: Objective post-operative urinary function obtained from validated questionnaires using univariate and multivariate logistic regression models to evaluate the impact of urinary symptoms on QOL. Results and limitations: Based on the validated questionnaires, 75% (75/112) of patients had low incontinence scores (0 to 8/24) at a mean follow-up of 37 months. On subjective assessment at the OPC, 82% (92/112) of patients were considered dry (pad free). The majority of patients had a high QOL score (109–156), indicating good quality of life. Urinary symptoms’ severity was significantly correlated with QOL, where severe symptoms were associated with lower QOL. A literature search revealed wide discrepancies in the assessment of functional outcomes following LRP rendering comparison between studies extremely difficult. Conclusions: The functional outcomes of LRP vary depending on the assessment used. There continues to be a lack of congruity between the methodologies used in the literature and few studies published have used validated questionnaires.
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Affiliation(s)
| | - Nikhil Vasdev
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Naeem Soomro
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Garrett C Durkan
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
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Sandhu GS, Nepple KG, Tanagho YS, Andriole GL. Laparoscopic Prostatectomy for Prostate Cancer. Surg Oncol Clin N Am 2013; 22:125-41, vii. [DOI: 10.1016/j.soc.2012.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Continence rate and oncological feasibility after total transurethral resection of the prostate as an alternative therapy for the treatment of prostate cancer: a pilot study. Int Neurourol J 2012; 15:222-7. [PMID: 22259737 PMCID: PMC3256308 DOI: 10.5213/inj.2011.15.4.222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/06/2011] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The value of total transurethral resection of prostate cancer (TURPC) as an alternative therapy was first recognized by Hans J. Reuter. Thus, we conducted the study of prospectively collected data to verify total TURPC as an alternative therapy forlocalized prostate cancer. METHODS From January 2008 to July 2011, 14 patients with a mean age of 76.1 years (range, 66 to 89 years) with clinically localized prostate cancer were treated by prostatic resection by the corresponding author with curative intention. RESULTS The mean duration of TURPC was 51.7 minutes (range, 30 to 120 minutes) and the mean amount of prostatic tissue resected was 21.2 g (range, 5 to 66 g). An intra- and/or postoperative blood transfusion was necessary in 2 cases. Hyponatremia was found in 7 patients. Six months after TURPC, 3 cases of grade 1 and 1 case of grade 2 incontinence were observed. Three patients in the high-risk group did not achieve a prostate specific antigen (PSA) nadir of ≤0.2 ng/mL. PSA recurrence occurred in one case in our series. Newly developed lymph node or distant metastases were not observed during the follow-up period. CONCLUSIONS According to our results, transurethral resection for prostate cancer can be performed with reasonable oncological results. The PSA nadir levels, and rates of biochemical failure and postoperative complications, including incontinence, were comparable with the published results for other procedures. TURPC is also inexpensive and non-invasive, and requires short hospitalization and a short surgical time without vesicourethral anastomosis.
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Older age does not impact perioperative complications after robot-assisted radical prostatectomy. J Robot Surg 2011; 5:201-8. [DOI: 10.1007/s11701-011-0251-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/10/2011] [Indexed: 11/26/2022]
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21
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Bastide C, Rozet F, Salomon L, Mongiat-Artus P, Beuzeboc P, Cormier L, Eiss D, Gaschignard N, Peyromaure M, Richaud P, Soulié M. [Critic analysis of a comparative meta-analysis on the morbidity, functional and carcinologic results after radical prostatectomy according to surgical approach. Work of cancerology committee of the French urological association]. Prog Urol 2010; 20:547-52. [PMID: 20832030 DOI: 10.1016/j.purol.2010.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 04/15/2010] [Accepted: 04/27/2010] [Indexed: 11/15/2022]
Abstract
Surgical approach for radical prostatectomy is even today a subject of debate in the urologic community. Many comparative studies between retropubic and laparoscopic approach (robotic assisted or not) were reported since 10 years without being able to decide between the supporters of retropubic or laparoscopic approach. The committee of cancer research of the French urological association took hold this question after a recent meta-analysis publication on this subject. Although imperfect, this meta-analysis exists and permits to conclude partially on the advantages and the inconveniences supposed for each surgical approach. Regarding morbidity after radical prostatectomy, the only significant difference reported concerns the hemorrhagic risk in favour of the laparoscopic approach. Regarding oncologic results, the only exploitable data concern positive surgical margins rate, which is identical whatever surgical approach. Concerning the functional results, no difference was reported in the literature between different surgical approaches.
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Affiliation(s)
- C Bastide
- Service d'urologie, hôpital Nord, pavillon l'étoile, chemin des Bourrely, 13015 Marseille, France.
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Stolzenburg JU, Do M, Kallidonis P, Ghulam N, Hellawell G, Haefner T, Liatsikos EN. Hemostasis During Nerve-Sparing Endoscopic Extraperitoneal Radical Prostatectomy. J Endourol 2010; 24:505-9. [DOI: 10.1089/end.2009.0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany
| | | | - Nabi Ghulam
- Department of Urology, University of Aberdeen, Aberdeen, Scotland
| | - Giles Hellawell
- Department of Urology, Northwick Park Hospital, London, United Kingdom
| | - Tim Haefner
- Department of Urology, University of Leipzig, Leipzig, Germany
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Xylinas E, Ploussard G, Paul A, Gillion N, Vordos D, Hoznek A, De La Taille A, Abbou CC, Salomon L. Prostatectomie radicale laparoscopique chez la personne âgée (>75ans) : résultats carcinologiques et fonctionnels. Prog Urol 2010; 20:116-20. [DOI: 10.1016/j.purol.2009.08.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 08/17/2009] [Accepted: 08/20/2009] [Indexed: 10/20/2022]
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24
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Tarragón Gabarró S, Lorente Garín JA, del Canto Aguirre M, Rijo Mora E, Bielsa Galí O, Arango Toro O. [Perioperative morbidity of radical prostatectomy in patients over 70 years of age]. Actas Urol Esp 2009; 33:960-4. [PMID: 19925755 DOI: 10.1016/s0210-4806(09)72894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Increased life expectancy has made possible radical treatment of localized prostate cancer in patients over 70 years of age. Perioperative morbidity of radical prostatectomy in elderly patients depending on surgical procedure has not been adequately analyzed. OBJECTIVES To comparatively analyze the incidence, severity, and management of perioperative complications of retropubic versus laparoscopic radical prostatectomy in patients older than 70 years. MATERIAL AND METHODS A retrospective review was made of 68 patients over 70 years of age (of whom 42 underwent retropubic and 26 laparoscopic radical prostatectomy) taken from a series of 500 patients. The modified Clavien classification was used to study complications from both surgical procedures. RESULTS The overall complication rate was 59.5% for the retropubic and 23% for the laparoscopic procedure (P=.003). Three grade I, 2 grade Id, 19 grade II, and 1 grade IId complications were seen with retropubic surgery, as compared to 2 grade I and 5 grade Id complications with the laparoscopic procedure. The most common complications included intraoperative bleeding (38%) and urinaryi fistula (15%) respectively. CONCLUSIONS Radical prostatectomy is a procedure that is not free from complications in patients older than 70 years, though these are usually mild. The advantages usually attributed to laparoscopy also apply to elderly patients, and should therefore be considered as the procedure of choice.
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Greco KA, Meeks JJ, Wu S, Nadler RB. Robot-assisted radical prostatectomy in men aged ≥70 years. BJU Int 2009; 104:1492-5. [DOI: 10.1111/j.1464-410x.2009.08718.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Peyromaure M, Mongiat-Artus P, Beuzeboc P, Richaud P, Bastide C, Cornud F, Gaschignard N, Molinié V, Rozet F, Staerman F, Soulié M, Salomon L. Résultats de la prostatectomie totale chez le patient âgé. Prog Urol 2009; 19 Suppl 3:S147-50. [DOI: 10.1016/s1166-7087(09)73362-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Reuter MA, Dietz K. [Radical transurethral resection of the prostate. An alternative therapy for the treatment of prostate cancer]. Urologe A 2009; 48:740-7. [PMID: 19484215 DOI: 10.1007/s00120-009-1982-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The value of radical transurethral resection of prostate cancer (TURPC) as an alternative therapy was investigated in this prospective study. From January 1995 to July 2008, 533 patients with a median age of 67 years (range 40-89 years) and with clinically localized prostate cancer were resected by the corresponding author with curative intention. The tumor stages were as follows: pT1 8%; pT2 61%; pT3 31%; G1 2%; G2 80%; G3 18%. TURPC requires continuous low-pressure irrigation with the irrigator liquid level at 10 cm water above the pubic region. It also requires a suprapubic trocar, a resectoscope with a 28F sheath, an autoregulated electrosurgical unit, and video monitoring. The prostate is resected completely with peripheral capsule and seminal vesicles. The specimen is retrieved in fractions for correct histopathological staging. If indicated, laparoscopic staging lymphadenectomy is performed. A secondary session for control of positive margins follows after 8 weeks. The transfusion rate was 1.5%, revision for hemorrhage 2.4%, lung embolism 0.2%, bladder neck incision 14%, grade 2 incontinence 0.6% out of 314, and impotence 30% out of 136. The prostate-specific antigen (PSA) nadir was < or =0.2 ng/ml in 95% of 444 cases. PSA recurrence at 5 years was 6% for pT1, 18% for pT2, and 31% for pT3. Postoperative survival at 10 years was 96% for pT1, 91% for pT2, and 85% for pT3 patients. Prostate cancer can be resected transurethrally with reasonable oncological results. The outcome with respect to survival and PSA recurrence is comparable with the results of other published procedures. Low-pressure irrigation with a suprapubic trocar is mandatory for safe performance.
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Affiliation(s)
- M A Reuter
- Urologische Klinik, Karl-Olga-Krankenhaus, Hackstrasse 61, 70190 Stuttgart.
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Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H. Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Systematic Review and Cumulative Analysis of Comparative Studies. Eur Urol 2009; 55:1037-63. [PMID: 19185977 DOI: 10.1016/j.eururo.2009.01.036] [Citation(s) in RCA: 684] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 01/16/2009] [Indexed: 12/11/2022]
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Liatsikos E, Rabenalt R, Burchardt M, Backhaus MR, Do M, Dietel A, Wasserscheid J, Constantinides C, Kallidonis P, Truss MC, Herrmann TR, Ganzer R, Stolzenburg JU. Prevention and management of perioperative complications in laparoscopic and endoscopic radical prostatectomy. World J Urol 2008; 26:571-80. [PMID: 18781306 DOI: 10.1007/s00345-008-0328-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 08/20/2008] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Laparoscopic transperitoneal radical prostatectomy (LRP) and endoscopic extraperitoneal radical prostatectomy (EERPE) are established techniques for the management of localized prostate cancer in numerous specialized urologic centers worldwide. RESULTS The complication rates of LRP and EERPE are ranging between 2 and 17%. Rare but possible complications are vascular injuries, bowel injury, lymphocele formation, port-site hernia, anastomotic leakage, gas embolism and catheter obstruction and other rare events. CONCLUSION Prevention and management of complications requires high surgical expertise and adequate standardization of the technique. MATERIALS AND METHODS We herein review our experience with the endoscopic extraperitoneal radical prostatectomy in a series of 1,800 consecutive patients regarding the appearance of complications and their management.
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Milhoua PM, Koi PT, Lowe D, Ghavamian R. Issue of Prostate Gland Size, Laparoscopic Radical Prostatectomy, and Continence Revisited. Urology 2008; 71:417-20. [DOI: 10.1016/j.urology.2007.10.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 09/04/2007] [Accepted: 10/21/2007] [Indexed: 10/22/2022]
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