1
|
López-Abad A, Server Gómez G, Loyola Maturana JP, Giménez Andreu I, Collado Serra A, Wong Gutiérrez A, Boronat Catalá J, de Pablos Rodríguez P, Gómez-Ferrer Á, Casanova Ramón-Borja J, Ramírez Backhaus M. Comparative evaluation of continence and potency after radical prostatectomy: Robotic vs. laparoscopic approaches, validating LAP-01 trial. Surg Oncol 2024; 55:102098. [PMID: 38991627 DOI: 10.1016/j.suronc.2024.102098] [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: 03/17/2024] [Revised: 06/12/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Minimally invasive techniques have demonstrated several advantages over the open approach. In the field of prostate cancer, the LAP-01 trial demonstrated the superiority of robotic-assisted radical prostatectomy (RARP) over laparoscopic radical prostatectomy (LRP) when comparing continence at 3-month after surgery, with no statistically significant differences at 6 and 12 months of follow-up. OBJECTIVES Externally validate the LAP-01 study and compare functional outcomes between the two minimally invasive approaches. MATERIAL AND METHODS This retrospective study, conducted by a single surgeon (MRB), utilized data from a prospectively collected database, which included patients who underwent both RARP or LRP. Data regarding baseline characteristics, continence (assessed through the 24-h Pad test and ICIQ questionnaire) and potency were collected at multiple time points: 1 and 6 weeks after catheter removal, 3-, 6-, and 12-months post-surgery. RESULTS The study encompasses 601 patients, 455 who underwent LRP and 146 RARP. The median age at diagnosis was 64 for LRP and 62 for RARP, while the median PSA levels at diagnosis were 6.7 ng/mL for LRP and 6.5 ng/mL for RARP. Bilateral nerve-sparing procedures were performed in 34.07 % of LRP cases and 51.37 % of RARP cases. RARP exhibited a significant advantage over LRP both in continence and potency. Continence rates at 3-, 6- and 9-month after radical prostatectomy (RP) were 36.43 %, 61.86 % and 79.87 % for LRP, compared to 50.98 %, 69.87 % and 91.69 % for RARP. Potency rates at the same intervals were 0.90 %, 3.16 % and 6.39 % for LRP, and 6.19 %, 9.16 % and 18.96 % for RARP. These rates were more pronounced in patients with bilateral nerve-sparing. CONCLUSION Our study demonstrates that RARP results in significantly better continence recovery and superior potency outcomes throughout the entire follow-up period compared to LRP, even at the beginning of the robotic approach learning curve.
Collapse
Affiliation(s)
- Alicia López-Abad
- Department of Urology, Virgen de La Arrixaca Hospital, Murcia, Spain.
| | | | | | | | | | | | - Juan Boronat Catalá
- Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Álvaro Gómez-Ferrer
- Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | | | | |
Collapse
|
2
|
Mizusawa J, Ogawa G, Terada M, Ishiki H, Kikawa Y, Kiyota N. Statistical Analysis Methods and Reporting of Patient-Reported Outcomes in Randomized Controlled Trials for Cancer Conducted in Japan: A Systematic Review. Cureus 2024; 16:e60804. [PMID: 38910767 PMCID: PMC11190813 DOI: 10.7759/cureus.60804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/25/2024] Open
Abstract
The Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) initiative was established in 2016 to assess the quality and standardization of patient-reported outcomes (PRO) data analysis in randomized controlled trials (RCTs) on advanced breast cancer. The initiative identified deficiencies in PRO data reporting, including nonstandardized methods for handling missing data. This study evaluated the reporting of health-related quality of life (HRQOL) in Japanese cancer RCTs to provide insights into the state of PRO reporting in Japan. The study reviewed PubMed articles published from 2010 to 2018. Eligible studies included Japanese cancer RCTs with ≥50 adult patients (≥50% were Japanese) with solid tumors receiving anticancer treatments. The evaluation criteria included clarity of the HRQOL hypotheses, multiplicity testing, primary analysis methods, and reporting of clinically meaningful differences. Twenty-seven HRQOL trials were identified. Only 15% provided a clear HRQOL hypothesis, and 63% examined multiple HRQOL domains without adjusting for multiplicity. Model-based methods were the most common statistical methods for the primary HRQOL analysis. Only 22% of the trials explicitly reported clinically meaningful differences in HRQOL. Baseline assessments were reported in most trials, but only 26% reported comparisons between the treatment groups. HRQOL analysis was based on the intention-to-treat population in 19% of the trials, and 74% reported compliance at follow-up; however, 41% did not specify how missing values were handled. Although the rates of reporting clinical hypotheses and clinically meaningful differences were relatively low, the current state of HRQOL evaluation in the Japanese cancer RCT appears comparable to that of previous studies.
Collapse
Affiliation(s)
- Junki Mizusawa
- Center for Research Administration and Support, National Cancer Center, Tokyo, JPN
| | - Gakuto Ogawa
- Center for Research Administration and Support, National Cancer Center, Tokyo, JPN
| | - Mitsumi Terada
- Department of International Clinical Development, National Cancer Center Hospital, Tokyo, JPN
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, JPN
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kansai Medical University, Osaka, JPN
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, JPN
| |
Collapse
|
3
|
Carrerette FB, Rodeiro DB, Filho RT, Santos PA, Lara CC, Damião R. Randomized controlled trial comparing open anterograde anatomic radical retropubic prostatectomy with retrograde technique. Asian J Urol 2023; 10:151-157. [PMID: 36942119 PMCID: PMC10023527 DOI: 10.1016/j.ajur.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/01/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Radical prostatectomy is the recommended treatment for localized prostate cancer; however, it is an invasive procedure that can leave serious morbidity. Robot-assisted radical prostatectomy was introduced with the aim of reducing postoperative morbidity and facilitating rapid recovery compared to the traditional Walsh's open radical retropubic prostatectomy. Therefore, a protocol was developed to perform an open prostatectomy comparable to that performed by robotics, but without involving novel instrumentation. Methods A total of 220 patients diagnosed with localized prostate cancer underwent radical prostatectomy. They were divided into two groups: anterograde technique (115 patients) and the retrograde method (105 patients). The study outcomes were observed 3 months after surgery. Results No differences were found in terms of surgical time, hospital stay, and suction drainage. However, reduced bleeding was observed in the anterograde technique (p=0.0003), with rapid anastomosis duration (p=0.005). Among the patients, 60.9% undergoing the anterograde technique were continent 3 months after surgery compared to 42.9% treated by the retrograde method (p=0.007). Additionally, fewer complications in terms of the number (p=0.007) and severity (p=0.0006) were observed in the anterograde technique. Conclusion The anterograde method displayed increased efficiency in reducing complications, compared to the retrograde technique.
Collapse
|
4
|
Pedraza AM, Wagaskar V, Parekh S, Tewari A. Technical advances in nerve-sparing and continence preservation. Curr Opin Urol 2022; 32:204-210. [PMID: 34954705 DOI: 10.1097/mou.0000000000000958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Urinary incontinence and erectile dysfunction are common after radical prostatectomy. These side effects greatly impact patients' quality of life. Therefore, surgical techniques and technology tools are constantly being developed to optimize trifecta outcomes. Here we focus on advances in nerve-sparing (NS) and continence preservation. RECENT FINDINGS New surgical techniques dedicated to preservation rather than reconstruction have been developed to improve urinary continence (UC) and NS. On the other hand, intraoperative assessment of prostatic and periprostatic structures has shown promising outcomes toward NS whereas avoiding omission of extracapsular extension (ECE). Likewise, neural regeneration strategies are under research to improve return of erectile function and UC. SUMMARY Superb outcomes after Robot-Assisted Radical Prostatectomy require a proper balance between NS and risk of ECE. Detailed anatomic knowledge together with an accurate surgical planning are cornerstone for tailoring the approach in each case.
Collapse
Affiliation(s)
- Adriana M Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | | |
Collapse
|
5
|
Stolzenburg JU, Holze S, Neuhaus P, Kyriazis I, Do HM, Dietel A, Truss MC, Grzella CI, Teber D, Hohenfellner M, Rabenalt R, Albers P, Mende M. Robotic-assisted Versus Laparoscopic Surgery: Outcomes from the First Multicentre, Randomised, Patient-blinded Controlled Trial in Radical Prostatectomy (LAP-01). Eur Urol 2021; 79:750-759. [PMID: 33573861 DOI: 10.1016/j.eururo.2021.01.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The LAP-01 trial was designed to address the lack of high-quality literature comparing robotic-assisted (RARP) and laparoscopic (LRP) radical prostatectomy. OBJECTIVE To compare the functional and oncological outcomes between RARP and LRP at 3 mo of follow-up. DESIGN, SETTING, AND PARTICIPANTS In this multicentre, randomised, patient-blinded controlled trial, patients referred for radical prostatectomy to four hospitals in Germany were randomly assigned (3:1) to undergo either RARP or LRP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was time to continence recovery at 3 mo based on the patient's pad diary. Secondary outcomes included continence and potency as well as quality of life in addition to oncological outcomes for up to 3 yr of follow-up. Time to continence was analysed by log-rank test and depicted by the Kaplan-Meier method. Continuous measurements were analysed by means of linear mixed models. RESULTS AND LIMITATIONS A total of 782 patients were randomised. The primary endpoint was evaluable in 718 patients (547 RARPs; full analysis set). At 3 mo, the difference in continence rates was 8.7% in favour of RARP (54% vs 46%, p = 0.027). RARP remained superior to LRP even after adjustment for the randomisation stratum nerve sparing and age >65 yr (hazard ratio = 1.40 [1.09-1.81], p = 0.008). A significant benefit in early potency recovery was also identified, while similar oncological and morbidity outcomes were documented. It is a limitation that the influence of different anastomotic techniques was not investigated in this study. CONCLUSIONS RARP resulted in significantly better continence recovery at 3 mo. PATIENT SUMMARY In this randomised trial, we looked at the outcomes following radical prostate surgery in a large German population. We conclude that patients undergoing robotic prostatectomy had better continence than those undergoing laparoscopic surgery when assessed at 3 mo following surgery. Age and the nerve-sparing technique further affected continence restoration.
Collapse
Affiliation(s)
| | - Sigrun Holze
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Petra Neuhaus
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Iason Kyriazis
- Department of Urology, University of Leipzig, Leipzig, Germany; Department of Urology, University Hospital of Patras, Rio, Greece
| | - Hoang Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany; Department of Urology, Sana Hospital Borna, Borna, Germany
| | - Anja Dietel
- Department of Urology, University of Leipzig, Leipzig, Germany
| | | | | | - Dogu Teber
- Department of Urology, University of Heidelberg, Heidelberg, Germany; Department of Urology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Robert Rabenalt
- Department of Urology, University of Duesseldorf, Duesseldorf, Germany; Department of Urology, Marien Hospital Duesseldorf, Duesseldorf, Germany
| | - Peter Albers
- Department of Urology, University of Duesseldorf, Duesseldorf, Germany
| | - Meinhard Mende
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig, Leipzig, Germany
| |
Collapse
|
6
|
Köhler N, El-Bandar N, Maxeiner A, Ralla B, Miller K, Busch J, Friedersdorff F. Early Continence and Extravasation After Open Retropubic Radical Prostatectomy - Interrupted vs Continuous Suturing for Vesicourethral Anastomosis. Ther Clin Risk Manag 2021; 16:1289-1296. [PMID: 33380800 PMCID: PMC7767697 DOI: 10.2147/tcrm.s278454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare running suture (RS) and interrupted suture (IS) of vesicourethral anastomosis (VUA) during open retropubic radical prostatectomy (RRP) on early urinary continence and extravasation. Patients and Methods Single center analysis of 211 patients who underwent RRP performed by a single surgeon during 2008 to 2017 was retrospectively analyzed. For VUA, we used the standard interrupted suture technique (n=100) with a 3-0 PDS suture. The RS (n=111) was performed with 12-bite suture using 3-0 PDS. The primary endpoints were extravasation and early continence. Demographic and peri-operative data were collected and analyzed using Pearson's chi-square, t-Test and Mann-Whitney U-test. A binary logistic regression analysis was carried out to explore predictors that affected early continence after catheter removal. Results The rates of early urinary incontinence (UI) were 7.7% vs 42.2% (p<0.001). The duration of catheterization and hospitalization was significantly shorter in the interrupted group (4 days vs 5 days, p<0.001 and 5 days vs 6 days, p<0.001). The groups did not differ significantly in body mass index or prostate volume. There were older patients and higher PSA levels in the group with RS technique. No significant difference was found in the postoperative extravasation rates between both groups (13.5% vs 12%, p=0.742). Conclusion Running vesicourethral anastomosis increased the rate of early urinary incontinence. Both anastomosis techniques provided a similar rate of postoperative urine extravasation. VUA should only be one of the many criteria that must be considered for the preservation of urinary continence of patients after RRP.
Collapse
Affiliation(s)
- Nora Köhler
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Nasrin El-Bandar
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Bernhard Ralla
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Jonas Busch
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| |
Collapse
|
7
|
Wu RC, Prebay ZJ, Patel P, Kim T, Qi J, Telang J, Linsell S, Kleer E, Miller DC, Peabody JO, Ghani KR, Johnston WK. Using video review to understand the technical variation of robot-assisted radical prostatectomy in a statewide surgical collaborative. World J Urol 2019; 38:1607-1613. [PMID: 31444604 DOI: 10.1007/s00345-019-02906-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/09/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Video assessment is an emerging tool for understanding surgical technique. Patient outcomes after robot-assisted radical prostatectomy (RARP) may be linked to technical aspects of the procedure. In an effort to refine surgical approaches and improve outcomes, we sought to understand technical variation for the key steps of RARP in a surgical collaborative. METHODS The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative with the aim of improving prostate cancer care. MUSIC surgeons were invited to submit representative complete videos of nerve-sparing RARP for blinded analysis. We also analyzed peri-operative outcomes from these surgeons in the registry. RESULTS Surgical video data from 20 unique surgeons identified many variations in technique and time to complete different steps. Common to all surgeons was a transperitoneal approach and a running urethrovesical anastomosis. Prior to anastomosis, 25% surgeons undertook a posterior reconstruction and 30% employed urethral suspension. 65% surgeons approached the seminal vesicle anteriorly. For control of the dorsal vein complex, suture ligation was used in 60%, and vascular stapler was 15%. The majority (80%) of surgeons employed clips for managing pedicles. In examining patient outcomes for surgeons, peri-operative outcomes were not correlated with surgeon's operative time; however, surgeons with an EBL > 400 ml had significant difference among the five different techniques employed. CONCLUSIONS Despite the worldwide popularity of RARP, the operation is still far from standardized. Correlating variation in technique with clinical outcomes may help provide objective data to support best practices with the goal to improve patient outcomes.
Collapse
Affiliation(s)
- Richard C Wu
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.,Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
| | - Zachary J Prebay
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parin Patel
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | - Tae Kim
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Ji Qi
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Jaya Telang
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Susan Linsell
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Eduardo Kleer
- IHA-Urology, St. Joseph Healthcare, Ypsilanti, MI, USA
| | - David C Miller
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | | | | |
Collapse
|
8
|
Interrupted versus Continuous Suturing for Vesicourethral Anastomosis During Radical Prostatectomy: A Systematic Review and Meta-analysis. Eur Urol Focus 2018; 5:980-991. [PMID: 29907547 DOI: 10.1016/j.euf.2018.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/28/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022]
Abstract
CONTEXT Vesicourethral anastomosis (VUA) is a crucial step during radical prostatectomy (RP). Generally, either a continuous (CS) or an interrupted suture (IS) is used. However, there is no clear evidence if one technique is superior to the other. OBJECTIVE This study aimed to provide a systematic overview and comparison between IS and CS for the VUA during RP. EVIDENCE ACQUISITION The study was conducting according to the PRISMA guidelines. A systematic data base search (Pubmed, Embase, and Central) was performed. Outcomes included catheterization time, extravasation, anastomotic time, length of hospital stay, continence, and development of strictures. EVIDENCE SYNTHESIS A total of 2021 studies were retrieved, of which nine studies (1475 patients) were included in analysis. Results showed a shorter catheterization time (2.06 d; 95% confidence interval [CI]: 0.56-3.57; p=0.007), anastomotic time (6.39min; 95% CI: 3.68-9.10; p<0.001), and a lower rate of extravasation (odds ratio [OR]: 2.36; 95% CI: 1.26-4.43; p<0.007) in favor of CS. There were no differences between groups concerning length of hospital stay (0.40 d; 95% CI: -1.41-2.20; p=0.670) or continence at 3 mo (OR: 1.09; 95% CI: 0.83-1.44; p=0.540), 6 mo (OR: 1.04; 95% CI: 0.67-1.61; p=0.870) or 12 mo (OR: 1.43; 95% CI: 0.92-2.24; p=0.110), respectively. The incidence of urethral strictures was not different between the techniques (OR: 1.00; 95% CI: 0.42-2.40; p=1.000). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation tool was rated as low. CONCLUSIONS This meta-analysis showed advantages of CS for catheterization time, anastomotic time, and rate of extravasation without compromising other parameters. Although CS seems to offer favorable results, its technical challenge in open RP and the generally low quality of data makes a clear recommendation impossible. PATIENT SUMMARY Continuous and interrupted suturing are safe suture techniques for the vesicourethral anastomosis during radical prostatectomy. The choice of the suture technique should be based on surgeon's experience and technical approach. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42017076126.
Collapse
|