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Ahtinen M, Vironen J, Murtola TJ. Previous inguinal hernia surgery does not limit the likelihood of choosing prostatectomy as primary prostate cancer therapy. Sci Rep 2024; 14:9943. [PMID: 38688937 PMCID: PMC11061137 DOI: 10.1038/s41598-024-60451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/23/2024] [Indexed: 05/02/2024] Open
Abstract
We evaluated whether previous inguinal hernia repair may affect the choice of prostate carcinoma treatment in a population-based cohort. It has been suggested that previous laparoscopic inguinal hernia repair (LIHR) could limit the subsequent possibility of performing a prostatectomy. Several small studies have suggested otherwise. The study cohort included all new prostate cancer cases in Finland 1998-2015 identified through the Finnish cancer registry. Data on the treatment of prostate cancer and surgical inguinal hernia repairs in 1998-2016 was obtained from the HILMO hospital discharge registry. After linkage, the study cohort included 7206 men. Of these, 5500 had no history of inguinal hernia, 1463 had an open hernia repair, and 193 had a minimally invasive repair (LIHR). Compared to men with no history of hernia repair, those with previous hernia repairs were more likely to undergo prostatectomy over radiation therapy as the primary treatment for prostate cancer HR 1.34 (CI 95% 1.19-1.52). The association did not depend on the method of hernia repair, HR 1.58 (CI 95% 1.15-2.18), in men with previous LIHR. The increased likelihood of choosing prostatectomy over radiation therapy concerns all type prostatectomies. Previous hernia repair is not a limiting factor when choosing treatment for prostate cancer.
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Affiliation(s)
- Mikko Ahtinen
- Department of Surgery, TAYS Cancer Center, Tampere, Finland.
- Department of Surgery, Tampere University Hospital, Elämänaukio 2, PL 2000, 33521, Tampere, Finland.
| | - Jaana Vironen
- Jorvi Hospital, Helsinki University Hospital Abdominal Center, Helsinki, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Urology, TAYS Cancer Center, Tampere, Finland
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Westhofen T, Bensel M, Schlenker B, Becker A, Stief CG, Kretschmer A, Buchner A. The impact of previous inguinal mesh hernioplasty on oncological and patient-reported outcomes following radical prostatectomy. Prostate 2023; 83:1313-1322. [PMID: 37394751 DOI: 10.1002/pros.24593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The impact of previous inguinal mesh hernioplasty (MH) with non-resorbable mesh prostheses on surgical performance of radical prostatectomy (RP) has been controversially discussed, with unknown impact of MH on oncologic outcomes and health-related quality of life (HRQOL) following RP. We therefore aimed to assess the influence of previous MH on metastasis-free survival (MFS), biochemical recurrence-free survival (BRFS), and HRQOL following RP. METHODS We identified 344 patients with previous MH prior RP within our prospectively assessed institutional database of 6275 patients treated with RP for PC (2008-2019). A 1:3 propensity-score matched analysis of 1345 men (n = 319 previous MH, n = 1026 no previous MH) was conducted. Primary endpoint was MFS and secondary endpoints were BRFS and HRQOL (based on EORTC QLQ-C30). Binary logistic regression, Kaplan-Meier, and Cox regression models tested the effect of previous MH on MFS, BRFS, and HRQOL (p < 0.05). RESULTS Median follow-up was 47 months. Patients with previous MH had significantly lower 5-year MFS (72% vs. 85%, p < 0.001) and 5-year BRFS estimates (43% vs. 57%, p < 0.001). In multivariate analysis, previous MH was confirmed as an independent predictor for impaired MFS (hazard ratio [HR]: 3.772, 95% CI 1.12-12.64, p = 0.031) and BRFS (HR: 1.862, 95% CI: 1.22-2.85, p = 0.004). These results held true if stratified for surgical approach or limited to patients with successful PLND. We found significantly shorter median time to continence recovery for patients without previous MH (p = 0.001) without significant differences in total continence recovery rates, erectile function recovery, and HRQOL. CONCLUSIONS Our findings show an impaired oncologic outcome for patients with previous MH following RP with no significant differences regarding continence recovery, erectile function recovery, and general HRQOL.
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Affiliation(s)
- Thilo Westhofen
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Moritz Bensel
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
- Janssen Global Research and Development, Los Angeles, California, USA
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Peitsch WKJ. Laparoscopic transperitoneal inguinal hernioplasty (TAPP) after radical open retropubic prostatectomy: special features and clinical outcomes. Hernia 2018; 23:281-286. [DOI: 10.1007/s10029-018-1846-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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Surgical technique and outcomes of transabdominal preperitoneal inguinal hernia repair after radical prostatectomy: dissection between the transversalis fascia and superficial layers of preperitoneal fascia. Hernia 2018; 23:167-174. [PMID: 30047042 DOI: 10.1007/s10029-018-1800-6] [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: 02/07/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The question as to whether laparoscopic surgery should be applied for inguinal hernia after radical prostatectomy remains a debate due to surgical difficulty arising from adhesions in the prevesical space. We report the surgical technique used in our department, its outcomes, and its safety and effectiveness compared with the surgical outcomes of primary transabdominal preperitoneal inguinal hernia repair (TAPP) cases. METHODS AND MATERIALS From February 2013 to January 2017, 30 patients with inguinal hernia were treated with TAPP after radical prostatectomy. At our institution, to avoid bladder injury, we dissect the prevesical space with the layer between the transversalis fascia and superficial layers of the preperitoneal fascia as the dissection plane. The practitioners were three qualified surgeons. Surgical outcome were compared with those of primary TAPP cases. For statistical analyses, we used t test to compare the mean operative durations and Chi square test to compare all other surgical outcomes. RESULTS The median observation period was 19 months. Intraoperative and postoperative complications did not occur; no onset of recurrence and chronic pain was observed. The mean operative duration was 116.2 min, which was significantly longer than that of primary TAPP patients (87.9 min). However, the operative duration for the last 14 patients had reduced to 101.6 min, which was not significantly different from that of primary TAPP patients. CONCLUSION In TAPP for patients following prostatectomy, surgery can be performed safely and reliably without prolonging the operative duration by selecting a skilled practitioner and standardizing the technique.
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Extraperitoneal vs. transperitoneal robot-assisted radical prostatectomy in patients with a history of prior inguinal hernia repair with mesh. J Robot Surg 2017; 11:447-454. [DOI: 10.1007/s11701-017-0678-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
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AL-Shareef AH, Akin Y, Almouhissen T, Rassweiler J, Alshehri MS, Gözen AS, Teber D. Effects of Previous Hernia Repair on Extraperitoneal Robot-Assisted Radical Prostatectomy: A Matched-Pair Analysis Study. J Endourol 2015; 29:1143-7. [DOI: 10.1089/end.2015.0112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmed H. AL-Shareef
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Yigit Akin
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Turky Almouhissen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | | | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Dogu Teber
- Department of Urology, University Hospital of Heidelberg, Heidelberg, Germany
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Li CC. Editorial comment on “Minimal incisions for laparoscopic radical cystectomy with extracorporeal-assisted urinary diversion”. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Feasibility and outcomes regarding open and laparoscopic radical prostatectomy in patients with previous synthetic mesh inguinal hernia repair: meta-analysis and systematic review of 7,497 patients. World J Urol 2014; 33:59-67. [DOI: 10.1007/s00345-014-1282-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 03/17/2014] [Indexed: 10/25/2022] Open
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Claus CMP, Coelho JCU, Campos ACL, Cury Filho AM, Loureiro MP, Dimbarre D, Bonin EA. Laparoscopic inguinal hernioplasty after radical prostatectomy: is it safe? Prospective clinical trial. Hernia 2013; 18:255-9. [PMID: 24357238 DOI: 10.1007/s10029-013-1204-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/06/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite inguinal hernia repair being one of the most common elective operations performed in general surgical practice, there are many controversies including indications for repair and selection of the surgical technique. In recent years, laparoscopic repair has gained wider acceptance because it is associated with fewer postoperative complications and less chronic pain when compared with conventional approaches with similar recurrence rate. However, patients with lower abdominal surgery are contraindicated for laparoscopic approach. There are few studies that evaluated whether patients who have been subjected to radical prostatectomy might be subjected to laparoscopic hernia repair with the same benefits as those without previous radical prostatectomy. METHODS Between March 2010 and March 2013, 20 consecutive patients, who had been subjected to prior radical prostatectomy, underwent laparoscopic transabdominal inguinal repair and were followed prospectively. Surgical procedure was performed using a standard technique. RESULTS Mean operative time was 67.5 min. There was only one (5%) intraoperative minor complication, an injury to the inferior epigastric vessels, which was managed by clipping of the vessels. There were no major postoperative complications. After 24 h and on the seventh postoperative day, 85 and 90% of patients had no pain or only complained of discomfort, respectively. Nine patients (45%) did not need any analgesics postoperatively. The mean time to return to leisure activities and to work was 3.1 and 5.6 days, respectively. There was no conversion to open surgery. All patients were discharged within 24 h. After a mean follow-up of 14 months, none of the patients presented recurrence. CONCLUSION TAPP after prostatectomy is safe and effective. It seems that patients undergoing laparoscopic repair after radical prostatic resection have the same benefits as those without prostatectomy.
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Affiliation(s)
- C M P Claus
- Minimally Invasive Surgery, Jacques Perissat Institute, Positivo University, R. Comendador Araujo, 143 Cj 113, Curitiba, PR, 80420-000, Brazil,
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Haifler M, Benjamin B, Ghinea R, Avital S. The Impact of Previous Laparoscopic Inguinal Hernia Repair on Radical Prostatectomy. J Endourol 2012; 26:1458-62. [DOI: 10.1089/end.2012.0285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miki Haifler
- Department of Urology, “Chaim Sheba” Medical Center, Tel-Hashomer, Israel
| | - Barak Benjamin
- Department of Surgery B, Meir Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronen Ghinea
- Department of Surgery B, Meir Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Avital
- Department of Surgery B, Meir Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Peeters E, Joniau S, Van Poppel H, Miserez M. Case-matched analysis of outcome after open retropubic radical prostatectomy in patients with previous preperitoneal inguinal hernia repair. Br J Surg 2011; 99:431-5. [DOI: 10.1002/bjs.7832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2011] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The impact of preperitoneal mesh repair for inguinal hernia on future pelvic surgery is debatable. This retrospective study investigated the impact of previous preperitoneal inguinal hernia repair (PIHR) on outcome after open retropubic radical prostatectomy (RRP) for prostatic cancer.
Methods
Patients who had open RRP and who had previously undergone PIHR were identified. They were compared with a control group of patients matched for age, body mass index and tumour risk profile who had no history of inguinal hernia repair. Outcome measures included intraoperative data, histopathology and results at follow-up.
Results
Sixty patients who had undergone open RRP after a previous PIHR were compared with 60 control patients. Operations lasted longer in the PIHR group (median (interquartile range, i.q.r.) 100 (90–120) versus 90 (85–100) min respectively; P < 0·001) and the operation was assessed as more difficult by the surgeon (P = 0·022). Hospital stay was longer for patients who had undergone PIHR (median (i.q.r.) 7 (6–9) versus 6 (5–7) days; P = 0·012) and urinary catheterization was prolonged (13 (11–14) versus 11 (11–12) days; P = 0·006). Among patients with intermediate- and high-risk disease, fewer lymph nodes were excised in the PIHR group than in the control group (median (i.q.r.) 2 (0–7) versus 8 (5–12) nodes; P < 0·001).
Conclusion
Open RRP for prostatic cancer was more difficult to perform after previous PIHR, and was associated with a longer hospital stay and less adequate lymphadenectomy for intermediate- and high-risk prostatic cancer.
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Affiliation(s)
- E Peeters
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - H Van Poppel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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