1
|
Zhang L, Wu B, Zha Z, Zhao H, Yuan J, Jiang Y, Yang W. Surgical margin status and its impact on prostate cancer prognosis after radical prostatectomy: a meta-analysis. World J Urol 2018; 36:1803-1815. [PMID: 29766319 PMCID: PMC6208659 DOI: 10.1007/s00345-018-2333-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022] Open
Abstract
Background and purpose Positive surgical margins (PSMs) correlate with adverse outcomes in numerous solid tumours. However, the prognostic value of PSMs in prostate cancer (PCa) patients who underwent radical prostatectomy remains unclear. Herein, we performed a meta-analysis to evaluate the association between PSMs and the prognostic value for biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), overall survival (OS), cancer-specific mortality (CSM) and overall mortality (OM) in PCa patients. Materials and methods According to the PRISMA statement, online databases PubMed, EMBASE and Web of Science were searched to identify relevant studies published prior to February 2018. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated to evaluate the relationship between PSMs and PCa. Results Ultimately, 32 cohort studies that met the eligibility criteria and involved 141,222 patients (51–65,633 per study) were included in this meta-analysis. The results showed that PSMs were significantly predictive of poorer BRFS (HR = 1.35, 95% CI 1.28–1.48, p < 0.001), CSS (HR = 1.49, 95% CI 1.16–1.90, p = 0.001) and OS (HR = 1.11, 95% CI 1.02–1.20, p = 0.014). In addition, PSMs were significantly associated with higher risk of CSM (HR = 1.23, 95% CI 1.16–1.30, p < 0.001) and OM (HR = 1.09, 95% CI 1.02–1.16, p = 0.009) in patients with PCa. Conclusions Our study suggests that the presence of a histopathologic PSM is associated with the clinical outcomes BRFS, CSS, OS, CSM and OM in patients with PCa, and PSMs could serve as a poor prognostic factor for patients with PCa. Electronic supplementary material The online version of this article (10.1007/s00345-018-2333-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lijin Zhang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Bin Wu
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China.
| | - Zhenlei Zha
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Hu Zhao
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Jun Yuan
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Yuefang Jiang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Wei Yang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| |
Collapse
|
2
|
Abstract
AIM To scrutinize the rapid development of robotic versus traditional laparoscopic technique in pelvic urologic surgery. INTRODUCTION In the last few decades, advances in research and development have led to tremendous progress in medical diagnostics and treatment of disease. Minimally invasive surgery has moved from experimental to becoming the dominant form of surgical management across the surgical specialties. Laparoscopy is nowadays used widely in abdominal surgery, from simple diagnostic laparoscopy to complex colorectal and gynecologic cancer procedures. METHODS A literature search of electronic databases (PubMed, Medscape, Embase) using the key words: "pelvic laparoscopy, urologic oncology, robotic surgery, minimally invasive access" was performed for all relevant articles in the English language. Data were extrapolated from the abstracts alone to avoid subjective bias in drawing conclusions. RESULTS Telemedicine and telesurgery, the diagnostic and operative process is conducted from a distance. The surgeon uses computer-assisted surgery away from the bedside via a robotic system and performs the surgical task at hand. In pelvic urological cancer surgery the use of robotic technique expands to female and reconstructive procedures as well. The leap forward is so massive, that traditional laparoscopic surgery is starting to be considered less, with a growing number of organizations being now more interested in developing a robotic service. Minimally invasive surgical techniques aim to improve surgical outcome in conjunction with delivery of high-quality patient care. Quality studies demonstrating superiority and cost effectiveness are lacking, however. CONCLUSIONS Although tremendous accomplishments took place over a few years, there is still a lot of ground to be covered in standardizing the learning process and evaluating the outcome from the application of new technologies in the field of robotic pelvic surgery.
Collapse
|
3
|
Dias JA, Dall'oglio MF, Colombo JR, Coelho RF, Nahas WC. The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy. Int Braz J Urol 2017; 43:871-879. [PMID: 28537691 PMCID: PMC5678518 DOI: 10.1590/s1677-5538.ibju.2016.0526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/19/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction: This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radical Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP. Patients and Methods: 110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal approach that simulates the RALP technique was used. Results: The median operative time was 163 minutes (110-240), and this time significantly decreased through case 40, when the time plateaued (p=0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P=0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad). Conclusions: The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.
Collapse
Affiliation(s)
- José Anastácio Dias
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| | - Marcos F Dall'oglio
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| | - João Roberto Colombo
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| | - Rafael F Coelho
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| |
Collapse
|
4
|
Long-Term Oncologic Outcome of an Initial Series of Laparoscopic Radical Prostatectomy for Clinically Localized Prostate Cancer After a Median Follow-up of 10 Years. Clin Genitourin Cancer 2015; 14:290-7. [PMID: 26710661 DOI: 10.1016/j.clgc.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/22/2015] [Accepted: 11/11/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION When laparoscopic radical prostatectomy (LRP) was introduced as a novel treatment option for prostate cancer, it had to compete with the established open techniques. The short- and intermediate-term oncologic and functional outcomes were encouraging and comparable to those with retropubic radical prostatectomy. However, the long-term oncologic safety for LRP has yet to be fully elucidated. We evaluated the long-term oncologic outcomes of an initial series of patients who had undergone LRP. PATIENTS AND METHODS An initial unselected and consecutive series of 100 patients who had undergone LRP for clinically localized prostate cancer from 1999 to 2001 was identified. The pre-, intra-, and postoperative data were collected. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value of ≥ 0.2 ng/mL. The outcome measures were cancer control (CC), BCR-free survival (BCRFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS The mean patient age was 64 ± 7 years, and the mean preoperative PSA level was 9.6 ± 8.3 ng/mL. Of the 100 patients, 79 (79%) had stage pT2 and 15 (15%) had stage pT3 disease. Positive surgical margins were found in 25 patients (25%; 16.4% for pT2 and 40% for pT3). The median follow-up time was 126 months (range, 60-176 months). The 5-year CC rate was 82%. The estimated 10-year BCRFS was 83% and 80% for patients with stage pT2 and pT3 tumors, respectively. The median time to BCR was 52 months (range, 6-144 months). The estimated 10-year CSS and OS was 98% and 93%, respectively. CONCLUSION Our long-term follow-up data from an initial unselected patient cohort have indicated that LRP offers excellent long-term oncologic control for patients with localized prostate cancer.
Collapse
|
5
|
Soares R, Di Benedetto A, Dovey Z, Bott S, McGregor RG, Eden CG. Minimum 5-year follow-up of 1138 consecutive laparoscopic radical prostatectomies. BJU Int 2015; 115:546-53. [PMID: 25098710 DOI: 10.1111/bju.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the long-term outcomes of laparoscopic radical prostatectomy (LRP). PATIENTS AND METHODS In all, 1138 patients underwent LRP during a 163-month period from 2000 to 2008, of which 51.5%, 30.3% and 18.2% were categorised into D'Amico risk groups of low-, intermediate- and high-risk, respectively. All intermediate- and high-risk patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning, and had a pelvic lymph node dissection (PLND), which was extended after April 2008. The median (range) patient age was 62 (40-78) years; body mass index was 26 (19-44) kg/m(2) ; prostate-specific antigen level was 7.0 (1-50) ng/mL and Gleason score was 6 (6-10). Neurovascular bundle was preservation carried out in 55.3% (bilateral 45.5%; unilateral 9.8%) of patients. RESULTS The median (range) gland weight was 52 (14-214) g. The median (range) operating time was 177 (78-600) min and PLND was performed in 299 patients (26.3%), of which 54 (18.0%) were extended. The median (range) blood loss was 200 (10-1300) mL, postoperative hospital stay was 3 (2-14) nights and catheterisation time was 14 (1-35) days. The complication rate was 5.2%. The median (range) LN count was 12 (4-26), LN positivity was 0.8% and the median (range) LN involvement was 2 (1-2). There was margin positivity in 13.9% of patients and up-grading in 29.3% and down-grading in 5.3%. While 11.4% of patients had up-staging from T1/2 to T3 and 37.1% had down-staging from T3 to T2. One case (0.09%) was converted to open surgery and six patients were transfused (0.5%). At a mean (range) follow-up of 88.6 (60-120) months, 85.4% of patients were free of biochemical recurrence, 93.8% were continent and 76.6% of previously potent non-diabetic men aged <70 years were potent after bilateral nerve preservation. CONCLUSIONS The long-term results obtainable from LRP match or exceed those previously published in large contemporary open and robot-assisted surgical series.
Collapse
Affiliation(s)
- Ricardo Soares
- Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, UK
| | | | | | | | | | | |
Collapse
|
6
|
|
7
|
Mei XC, Sun B, Xu JM, Kong DR. Clinical effects of endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric and esophageal cancer and precancerous lesions. Shijie Huaren Xiaohua Zazhi 2014; 22:4954-4959. [DOI: 10.11569/wcjd.v22.i32.4954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility, safety and efficacy of endoscopic mucosal resection (EMR) vs endoscopic submucosal dissection (ESD) for early gastric and esophageal cancer and precancerous lesions.
METHODS: A retrospective analysis was performed of 93 patients with early gastric/esophageal cancer or precancerous lesions who were endoscopically and pathologically diagnosed and managed by ESD or EMR at our hospital from March 2011 to June 2014. The patients were divided into either an ESD group (61 patients) or an EMR group (32 patients). The operative time, size of the lesion, en bloc resection rate, surgical complications and postoperative recurrence were compared for the two groups to evaluate their feasibility, safety and efficacy.
RESULTS: There was no significant difference in age or lesion size between the two groups. The en bloc rate was significantly higher in the ESD group than in the EMR resection (91.8% vs 56.3%, P < 0.05). There are five cases of bleeding in the ESD group and one in the EMR group, and no delayed bleeding occurred in either group. There was only one case of perforation, which occurred in the ESD group. During the 3-42-month postoperative follow-up, there was no recurrence in the ESD group, but four cases of recurrence occurred in the EMR group.
CONCLUSION: Compared with EMR for early gastric and esophageal cancer and precancerous lesions, ESD shows considerable advantages regarding en bloc resection rate and local recurrence, although there is no significant difference in bleeding or perforation.
Collapse
|
8
|
Good DW, Khan A, Hammer S, Scanlan P, Shu W, Phipps S, Parson SH, Stewart GD, Reuben R, McNeill SA. Tissue quality assessment using a novel direct elasticity assessment device (the E-finger): a cadaveric study of prostatectomy dissection. PLoS One 2014; 9:e112872. [PMID: 25384014 PMCID: PMC4226612 DOI: 10.1371/journal.pone.0112872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Minimally invasive radical prostatectomy (RP) (robotic and laparoscopic), have brought improvements in the outcomes of RP due to improved views and increased degrees of freedom of surgical devices. Robotic and laparoscopic surgeries do not incorporate haptic feedback, which may result in complications secondary to inadequate tissue dissection (causing positive surgical margins, rhabdosphincter damage, etc). We developed a micro-engineered device (6 mm2 sized) [E-finger]) capable of quantitative elasticity assessment, with amplitude ratio, mean ratio and phase lag representing this. The aim was to assess the utility of the device in differentiating peri-prostatic tissue types in order to guide prostate dissection. Material and Methods Two embalmed and 2 fresh frozen cadavers were used in the study. Baseline elasticity values were assessed in bladder, prostate and rhabdosphincter of pre-dissected embalmed cadavers using the micro-engineered device. A measurement grid was created to span from the bladder, across the prostate and onto the rhabdosphincter of fresh frozen cadavers to enable a systematic quantitative elasticity assessment of the entire area by 2 independent assessors. Tissue was sectioned along each row of elasticity measurement points, and stained with haematoxylin and eosin (H&E). Image analysis was performed with Image Pro Premier to determine the histology at each measurement point. Results Statistically significant differences in elasticity were identified between bladder, prostate and sphincter in both embalmed and fresh frozen cadavers (p = <0.001). Intra-class correlation (ICC) reliability tests showed good reliability (average ICC = 0.851). Sensitivity and specificity for tissue identification was 77% and 70% respectively to a resolution of 6 mm2. Conclusions This cadaveric study has evaluated the ability of our elasticity assessment device to differentiate bladder, prostate and rhabdosphincter to a resolution of 6 mm2. The results provide useful data for which to continue to examine the use of elasticity assessment devices for tissue quality assessment with the aim of giving haptic feedback to surgeons performing complex surgery.
Collapse
Affiliation(s)
- Daniel W. Good
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
- * E-mail:
| | - Ashfaq Khan
- Department of Anatomy, University of Edinburgh, Edinburgh, United Kingdom
| | - Steven Hammer
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Paul Scanlan
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Wenmiao Shu
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - Simon Phipps
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| | - Simon H. Parson
- Department of Anatomy, University of Edinburgh, Edinburgh, United Kingdom
| | - Grant D. Stewart
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| | - Robert Reuben
- School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom
| | - S. Alan McNeill
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| |
Collapse
|
9
|
Laird A, Fowler S, Good DW, Stewart GD, Srinivasan V, Cahill D, Brewster SF, McNeill SA. Contemporary practice and technique-related outcomes for radical prostatectomy in the UK: a report of national outcomes. BJU Int 2014; 115:753-63. [DOI: 10.1111/bju.12866] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Alexander Laird
- Department of Urology; Western General Hospital; Edinburgh UK
| | - Sarah Fowler
- The British Association of Urological Surgeons; London UK
| | - Daniel W. Good
- Department of Urology; Western General Hospital; Edinburgh UK
| | | | | | - Declan Cahill
- Department of Urology; Guy's and St Thomas' NHS Hospital Trust; London UK
| | | | - S. Alan McNeill
- Department of Urology; Western General Hospital; Edinburgh UK
| | | |
Collapse
|
10
|
Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status. Wideochir Inne Tech Maloinwazyjne 2014; 9:362-70. [PMID: 25337159 PMCID: PMC4198659 DOI: 10.5114/wiitm.2014.45085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/12/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Preservation of the bladder neck (BN) has been controversial, as limited excision of the bladder neck may result in incomplete resection of the disease. Moreover, the urinary continence rate may not be improved. AIM To evaluate the effect of bladder neck sparing on urinary continence, and surgical margins status in prostate cancer (PCa) patients treated with laparoscopic radical extraperitoneal prostatectomy. MATERIAL AND METHODS A retrospective analysis of 295 consecutive patients who had undergone laparoscopic radical extraperitoneal prostatectomy for clinically localised prostate cancer in a single institution was performed. Positive surgical margin (SM(+)) and urinary continence status at 3, 6, and 12 months were evaluated. RESULTS The distribution of SM(+) for pT2, pT3, and pT4a was 15.3% (27/176), 49.1% (58/118), and 100% (1/1), respectively. Overall, there were 55.61%, 80.61%, and 84.69% of men continent at 3, 6, and 12 months, respectively. However, when limiting the analysis to those who did not receive adjuvant radiotherapy within 12 months following surgery, urinary continence rates were 59.23%, 85.86%, and 90.21% at 3, 6, and 12 months, respectively. Preoperative prostate-specific antigen (PSA) and pathological T stage were identified as significant predictors of positive surgical margins. CONCLUSIONS CONCLUSIONS Laparoscopic radical extraperitoneal prostatectomy with bladder neck preservation has been a safe procedure which has resulted in good functional outcome. We observed a relatively high incidence of positive surgical margins which could be attributed to a large number of extracapsular disease cases.
Collapse
|
11
|
Luke S, Delprado W, Louie-Johnsun M. Teaching laparoscopic radical prostatectomy during the primary surgeon's early learning curve - analysis of our first 207 cases. BJU Int 2014; 114 Suppl 1:38-44. [DOI: 10.1111/bju.12799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Serge Luke
- Department of Urology; Gosford Hospital and Gosford Private Hospital; Gosford NSW Australia
| | | | - Mark Louie-Johnsun
- Department of Urology; Gosford Hospital and Gosford Private Hospital; Gosford NSW Australia
| |
Collapse
|
12
|
Azhar RA, Aron M. Mid-term UK outcomes data after extraperitoneal laparoscopic radical prostatectomy. BJU Int 2014; 113:354-5. [PMID: 24528879 DOI: 10.1111/bju.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Raed A Azhar
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
| | | |
Collapse
|