A Prospective Trial Comparing Consecutive Series of Open Retropubic and Robot-Assisted Laparoscopic Radical Prostatectomy in a Centre with a Limited Caseload
Abstract Background Robot-assisted radical prostatectomy (RALP) is performed worldwide, even in institutions with limited caseloads. However, although the results of large RALP series are available, oncologic and functional outcomes as well as complications from low-caseload centres are lacking. Obj...
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| creator | Di Pierro, Giovanni B Baumeister, Philipp Stucki, Patrick Beatrice, Josef Danuser, Hansjörg Mattei, Agostino |
| description | Abstract Background Robot-assisted radical prostatectomy (RALP) is performed worldwide, even in institutions with limited caseloads. However, although the results of large RALP series are available, oncologic and functional outcomes as well as complications from low-caseload centres are lacking. Objective To compare perioperative, oncologic, and functional outcomes from two consecutive series of patients with localised prostate cancer treated by retropubic radical prostatectomy (RRP) or recently established RALP in our hospital, which has a limited caseload. Design, setting, and participants One hundred fifty consecutive patients were enrolled. Their data and outcomes were collected and extensively evaluated. Intervention Seventy-five consecutive patients underwent RRP, and 75 consecutive patients underwent RALP, including all patients of the learning curve. Measurements Patient baseline characteristics, perioperative and postoperative outcomes, and complications were evaluated. End points were oncologic data (positive margins, prostate-specific antigen [PSA]), perioperative complications, urinary continence, and erectile function at 3- and 12-mo follow-up. Results and limitations The preoperative parameters from the two groups were comparable. The positive surgical margin (PSM) rates were 32% for RRP and 16% for RALP ( p = 0.002). For RRP and RALP, the PSA value was |
| doi_str_mv | 10.1016/j.eururo.2010.10.026 |
| format | Article |
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However, although the results of large RALP series are available, oncologic and functional outcomes as well as complications from low-caseload centres are lacking. Objective To compare perioperative, oncologic, and functional outcomes from two consecutive series of patients with localised prostate cancer treated by retropubic radical prostatectomy (RRP) or recently established RALP in our hospital, which has a limited caseload. Design, setting, and participants One hundred fifty consecutive patients were enrolled. Their data and outcomes were collected and extensively evaluated. Intervention Seventy-five consecutive patients underwent RRP, and 75 consecutive patients underwent RALP, including all patients of the learning curve. Measurements Patient baseline characteristics, perioperative and postoperative outcomes, and complications were evaluated. End points were oncologic data (positive margins, prostate-specific antigen [PSA]), perioperative complications, urinary continence, and erectile function at 3- and 12-mo follow-up. Results and limitations The preoperative parameters from the two groups were comparable. The positive surgical margin (PSM) rates were 32% for RRP and 16% for RALP ( p = 0.002). For RRP and RALP, the PSA value was <0.2 ng/ml in 91% and 88% of patients 3 mo postoperatively ( p = 0.708) and in 87% and 89% of patients 12 mo postoperatively ( p = 0.36), respectively. Continence rates for RRP and RALP were 83% and 95% at 3-mo follow-up ( p = 0.003) and 80% and 89% after 12-mo follow-up ( p = 0.092), respectively. Among patients who were potent without phosphodiesterase type 5 inhibitors (PDE5-I) before RRP and RALP, recovery of erectile function with and without PDE5-Is was achieved in 25% (12 of 49 patients) and 68% (25 of 37 patients) 3 mo postoperatively ( p = 0.009) and in 26% (12 of 47 patients) and 55% (12 of 22 patients) 12 mo postoperatively ( p = 0.009), respectively. Minimal follow-up for RRP was 12 mo; median follow-up for the RALP group was 12 mo (range: 3–12). According to the modified Clavien system, major complication rates for RRP and RALP were 28% and 7% ( p = 0.025), respectively; minor complication rates were 24% and 35% ( p = 0.744), respectively. Conclusions Despite a limited caseload and including the learning curve, RALP offers slightly better results than RRP in terms of PSM, major complications, urinary continence, and erectile function.</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2010.10.026</identifier><identifier>PMID: 21035248</identifier><identifier>CODEN: EUURAV</identifier><language>eng</language><publisher>Kidlington: Elsevier B.V</publisher><subject>Aged ; Biological and medical sciences ; Clinical Competence ; Erectile Dysfunction - drug therapy ; Erectile Dysfunction - etiology ; Gynecology. Andrology. Obstetrics ; Hospitals ; Humans ; Laparoscopy - adverse effects ; Learning Curve ; Limited caseload ; Lymph Node Excision ; Male ; Male genital diseases ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Oncologic and functional outcomes ; Phosphodiesterase 5 Inhibitors - therapeutic use ; Prospective Studies ; Prostate cancer ; Prostate-Specific Antigen - blood ; Prostatectomy - adverse effects ; Prostatectomy - methods ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - surgery ; Retropubic radical prostatectomy ; Robot-assisted radical prostatectomy ; Robotics ; Surgery, Computer-Assisted - adverse effects ; Switzerland ; Time Factors ; Treatment Outcome ; Tumors ; Tumors of the urinary system ; Urinary Incontinence - etiology ; Urinary tract. Prostate gland ; Urology ; Workload</subject><ispartof>European urology, 2011-01, Vol.59 (1), p.1-6</ispartof><rights>European Association of Urology</rights><rights>2010 European Association of Urology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-2fe4386ccf661759163e380eca2cacd8346d6f94908defe34a03a849bbfe80733</citedby><cites>FETCH-LOGICAL-c446t-2fe4386ccf661759163e380eca2cacd8346d6f94908defe34a03a849bbfe80733</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.eururo.2010.10.026$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23650775$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21035248$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Di Pierro, Giovanni B</creatorcontrib><creatorcontrib>Baumeister, Philipp</creatorcontrib><creatorcontrib>Stucki, Patrick</creatorcontrib><creatorcontrib>Beatrice, Josef</creatorcontrib><creatorcontrib>Danuser, Hansjörg</creatorcontrib><creatorcontrib>Mattei, Agostino</creatorcontrib><title>A Prospective Trial Comparing Consecutive Series of Open Retropubic and Robot-Assisted Laparoscopic Radical Prostatectomy in a Centre with a Limited Caseload</title><title>European urology</title><addtitle>Eur Urol</addtitle><description>Abstract Background Robot-assisted radical prostatectomy (RALP) is performed worldwide, even in institutions with limited caseloads. However, although the results of large RALP series are available, oncologic and functional outcomes as well as complications from low-caseload centres are lacking. Objective To compare perioperative, oncologic, and functional outcomes from two consecutive series of patients with localised prostate cancer treated by retropubic radical prostatectomy (RRP) or recently established RALP in our hospital, which has a limited caseload. Design, setting, and participants One hundred fifty consecutive patients were enrolled. Their data and outcomes were collected and extensively evaluated. Intervention Seventy-five consecutive patients underwent RRP, and 75 consecutive patients underwent RALP, including all patients of the learning curve. Measurements Patient baseline characteristics, perioperative and postoperative outcomes, and complications were evaluated. End points were oncologic data (positive margins, prostate-specific antigen [PSA]), perioperative complications, urinary continence, and erectile function at 3- and 12-mo follow-up. Results and limitations The preoperative parameters from the two groups were comparable. The positive surgical margin (PSM) rates were 32% for RRP and 16% for RALP ( p = 0.002). For RRP and RALP, the PSA value was <0.2 ng/ml in 91% and 88% of patients 3 mo postoperatively ( p = 0.708) and in 87% and 89% of patients 12 mo postoperatively ( p = 0.36), respectively. Continence rates for RRP and RALP were 83% and 95% at 3-mo follow-up ( p = 0.003) and 80% and 89% after 12-mo follow-up ( p = 0.092), respectively. Among patients who were potent without phosphodiesterase type 5 inhibitors (PDE5-I) before RRP and RALP, recovery of erectile function with and without PDE5-Is was achieved in 25% (12 of 49 patients) and 68% (25 of 37 patients) 3 mo postoperatively ( p = 0.009) and in 26% (12 of 47 patients) and 55% (12 of 22 patients) 12 mo postoperatively ( p = 0.009), respectively. Minimal follow-up for RRP was 12 mo; median follow-up for the RALP group was 12 mo (range: 3–12). According to the modified Clavien system, major complication rates for RRP and RALP were 28% and 7% ( p = 0.025), respectively; minor complication rates were 24% and 35% ( p = 0.744), respectively. Conclusions Despite a limited caseload and including the learning curve, RALP offers slightly better results than RRP in terms of PSM, major complications, urinary continence, and erectile function.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Clinical Competence</subject><subject>Erectile Dysfunction - drug therapy</subject><subject>Erectile Dysfunction - etiology</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Laparoscopy - adverse effects</subject><subject>Learning Curve</subject><subject>Limited caseload</subject><subject>Lymph Node Excision</subject><subject>Male</subject><subject>Male genital diseases</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Oncologic and functional outcomes</subject><subject>Phosphodiesterase 5 Inhibitors - therapeutic use</subject><subject>Prospective Studies</subject><subject>Prostate cancer</subject><subject>Prostate-Specific Antigen - blood</subject><subject>Prostatectomy - adverse effects</subject><subject>Prostatectomy - methods</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Retropubic radical prostatectomy</subject><subject>Robot-assisted radical prostatectomy</subject><subject>Robotics</subject><subject>Surgery, Computer-Assisted - adverse effects</subject><subject>Switzerland</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Tumors of the urinary system</subject><subject>Urinary Incontinence - etiology</subject><subject>Urinary tract. Prostate gland</subject><subject>Urology</subject><subject>Workload</subject><issn>0302-2838</issn><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUk2P0zAQjRCILQv_ACFfEKcUO3Yc54JURXxJlRZ1l7Pl2hNwSexgO4v6Y_a_rrMtIHHh5PHMmzf2e1MULwleE0z428Ma5jAHv67wQ2qNK_6oWBHR0LKpOX5crDDFVVkJKi6KZzEeMMa0bunT4qIiOaqYWBV3G_Ql-DiBTvYW0E2wakCdHycVrPuWIxdBzw-1awgWIvI9uprAoR2k4Kd5bzVSzqCd3_tUbmK0MYFBW5UZfNR-yvWdMlZn3mVSUinP8uMRWYcU6sClAOiXTd_zbWtHu3R3KsLglXlePOnVEOHF-bwsvn54f9N9KrdXHz93m22pGeOprHpgVHCte85JU7eEU6ACg1aVVtoIyrjhfctaLAz0QJnCVAnW7vc9CNxQelm8OfFOwf-cISY52qhhGJQDP0cp6kaQmtMmI9kJqfNfYoBeTsGOKhwlwXLxRR7kyRe5-LJksy-57dV5wLwfwfxp-m1EBrw-A1TMUvVBOW3jXxzlNW6aOuPenXCQ5bi1EGTUFpwGY0PWVRpv__eSfwn0YN1izw84Qjz4ObgstSQyVhLL62WHlhUieXtazhi9BxG1xPs</recordid><startdate>20110101</startdate><enddate>20110101</enddate><creator>Di Pierro, Giovanni B</creator><creator>Baumeister, Philipp</creator><creator>Stucki, Patrick</creator><creator>Beatrice, Josef</creator><creator>Danuser, Hansjörg</creator><creator>Mattei, Agostino</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110101</creationdate><title>A Prospective Trial Comparing Consecutive Series of Open Retropubic and Robot-Assisted Laparoscopic Radical Prostatectomy in a Centre with a Limited Caseload</title><author>Di Pierro, Giovanni B ; Baumeister, Philipp ; Stucki, Patrick ; Beatrice, Josef ; Danuser, Hansjörg ; Mattei, Agostino</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-2fe4386ccf661759163e380eca2cacd8346d6f94908defe34a03a849bbfe80733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Clinical Competence</topic><topic>Erectile Dysfunction - drug therapy</topic><topic>Erectile Dysfunction - etiology</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Laparoscopy - adverse effects</topic><topic>Learning Curve</topic><topic>Limited caseload</topic><topic>Lymph Node Excision</topic><topic>Male</topic><topic>Male genital diseases</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Oncologic and functional outcomes</topic><topic>Phosphodiesterase 5 Inhibitors - therapeutic use</topic><topic>Prospective Studies</topic><topic>Prostate cancer</topic><topic>Prostate-Specific Antigen - blood</topic><topic>Prostatectomy - adverse effects</topic><topic>Prostatectomy - methods</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Prostatic Neoplasms - surgery</topic><topic>Retropubic radical prostatectomy</topic><topic>Robot-assisted radical prostatectomy</topic><topic>Robotics</topic><topic>Surgery, Computer-Assisted - adverse effects</topic><topic>Switzerland</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Tumors of the urinary system</topic><topic>Urinary Incontinence - etiology</topic><topic>Urinary tract. Prostate gland</topic><topic>Urology</topic><topic>Workload</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Di Pierro, Giovanni B</creatorcontrib><creatorcontrib>Baumeister, Philipp</creatorcontrib><creatorcontrib>Stucki, Patrick</creatorcontrib><creatorcontrib>Beatrice, Josef</creatorcontrib><creatorcontrib>Danuser, Hansjörg</creatorcontrib><creatorcontrib>Mattei, Agostino</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Di Pierro, Giovanni B</au><au>Baumeister, Philipp</au><au>Stucki, Patrick</au><au>Beatrice, Josef</au><au>Danuser, Hansjörg</au><au>Mattei, Agostino</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Prospective Trial Comparing Consecutive Series of Open Retropubic and Robot-Assisted Laparoscopic Radical Prostatectomy in a Centre with a Limited Caseload</atitle><jtitle>European urology</jtitle><addtitle>Eur Urol</addtitle><date>2011-01-01</date><risdate>2011</risdate><volume>59</volume><issue>1</issue><spage>1</spage><epage>6</epage><pages>1-6</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><coden>EUURAV</coden><abstract>Abstract Background Robot-assisted radical prostatectomy (RALP) is performed worldwide, even in institutions with limited caseloads. However, although the results of large RALP series are available, oncologic and functional outcomes as well as complications from low-caseload centres are lacking. Objective To compare perioperative, oncologic, and functional outcomes from two consecutive series of patients with localised prostate cancer treated by retropubic radical prostatectomy (RRP) or recently established RALP in our hospital, which has a limited caseload. Design, setting, and participants One hundred fifty consecutive patients were enrolled. Their data and outcomes were collected and extensively evaluated. Intervention Seventy-five consecutive patients underwent RRP, and 75 consecutive patients underwent RALP, including all patients of the learning curve. Measurements Patient baseline characteristics, perioperative and postoperative outcomes, and complications were evaluated. End points were oncologic data (positive margins, prostate-specific antigen [PSA]), perioperative complications, urinary continence, and erectile function at 3- and 12-mo follow-up. Results and limitations The preoperative parameters from the two groups were comparable. The positive surgical margin (PSM) rates were 32% for RRP and 16% for RALP ( p = 0.002). For RRP and RALP, the PSA value was <0.2 ng/ml in 91% and 88% of patients 3 mo postoperatively ( p = 0.708) and in 87% and 89% of patients 12 mo postoperatively ( p = 0.36), respectively. Continence rates for RRP and RALP were 83% and 95% at 3-mo follow-up ( p = 0.003) and 80% and 89% after 12-mo follow-up ( p = 0.092), respectively. Among patients who were potent without phosphodiesterase type 5 inhibitors (PDE5-I) before RRP and RALP, recovery of erectile function with and without PDE5-Is was achieved in 25% (12 of 49 patients) and 68% (25 of 37 patients) 3 mo postoperatively ( p = 0.009) and in 26% (12 of 47 patients) and 55% (12 of 22 patients) 12 mo postoperatively ( p = 0.009), respectively. Minimal follow-up for RRP was 12 mo; median follow-up for the RALP group was 12 mo (range: 3–12). According to the modified Clavien system, major complication rates for RRP and RALP were 28% and 7% ( p = 0.025), respectively; minor complication rates were 24% and 35% ( p = 0.744), respectively. Conclusions Despite a limited caseload and including the learning curve, RALP offers slightly better results than RRP in terms of PSM, major complications, urinary continence, and erectile function.</abstract><cop>Kidlington</cop><pub>Elsevier B.V</pub><pmid>21035248</pmid><doi>10.1016/j.eururo.2010.10.026</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Biological and medical sciences Clinical Competence Erectile Dysfunction - drug therapy Erectile Dysfunction - etiology Gynecology. Andrology. Obstetrics Hospitals Humans Laparoscopy - adverse effects Learning Curve Limited caseload Lymph Node Excision Male Male genital diseases Medical sciences Middle Aged Nephrology. Urinary tract diseases Oncologic and functional outcomes Phosphodiesterase 5 Inhibitors - therapeutic use Prospective Studies Prostate cancer Prostate-Specific Antigen - blood Prostatectomy - adverse effects Prostatectomy - methods Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Retropubic radical prostatectomy Robot-assisted radical prostatectomy Robotics Surgery, Computer-Assisted - adverse effects Switzerland Time Factors Treatment Outcome Tumors Tumors of the urinary system Urinary Incontinence - etiology Urinary tract. Prostate gland Urology Workload |
| title | A Prospective Trial Comparing Consecutive Series of Open Retropubic and Robot-Assisted Laparoscopic Radical Prostatectomy in a Centre with a Limited Caseload |
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