Functional Recovery, Oncologic Outcomes and Postoperative Complications after Robot-Assisted Radical Prostatectomy: An Evidence-Based Analysis Comparing the Retzius Sparing and Standard Approaches

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Abstract

We report a 1-year update of functional urinary and sexual recovery, oncologic outcomes and postoperative complications in patients who completed a randomized controlled trial comparing posterior (Retzius sparing) with anterior robot-assisted radical prostatectomy.

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Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations.

Dionysios Mitropoulos, Walter Artibani, Markus Graefen … (2012)

The incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology. To review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes. Standardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature. To establish a possible change in attitude towards reporting of complications related to urologic procedures, we performed a systematic literature search of all papers reporting complications after urologic surgery published in European Urology, Journal of Urology, Urology, BJU International, and World Journal of Urology in 1999-2000 and 2009-2010. Data identification for the systematic assessment of the Clavien-Dindo system currently used for the reporting of complications related to urologic surgical interventions involved a Medline/Embase search and the search engines of individual urologic journals and publishers using Clavien, urology, and complications as keywords. All selected papers were full-text retrieved and assessed; analysis was done based on structured forms. The systematic review of the literature for standardised systems used for reporting and classification of surgical complications revealed five such systems. As far as the attitude of urologists towards reporting of complications, a shift could be seen in the number of studies using most of the Martin criteria, as well as in the number of studies using either standardised criteria or the Clavien-Dindo system. The latter system was not properly used in 72 papers (35.3%). Uniformed reporting of complications after urologic procedures will aid all those involved in patient care and scientific publishing (authors, reviewers, and editors). It will also contribute to the improvement of the scientific quality of papers published in the field of urologic surgery. When reporting the outcomes of urologic procedures, the committee proposes a series of quality criteria. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy.

Giacomo Novara, Vincenzo Ficarra, Raymond Rosen … (2012)

Perioperative complications are a major surgical outcome for radical prostatectomy (RP). Evaluate complication rates following robot-assisted RP (RARP), risk factors for complications after RARP, and surgical techniques to improve complication rates after RARP. We also performed a cumulative analysis of all studies comparing RARP with retropubic RP (RRP) or laparoscopic RP (LRP) in terms of perioperative complications. A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK). We retrieved 110 papers evaluating oncologic outcomes following RARP. Overall mean operative time is 152 min; mean blood loss is 166 ml; mean transfusion rate is 2%; mean catheterization time is 6.3 d; and mean in-hospital stay is 1.9 d. The mean complication rate was 9%, with most of the complications being of low grade. Lymphocele/lymphorrea (3.1%), urine leak (1.8%), and reoperation (1.6%) are the most prevalent surgical complications. Blood loss (weighted mean difference: 582.77; p<0.00001) and transfusion rate (odds ratio [OR]: 7.55; p<0.00001) were lower in RARP than in RRP, whereas only transfusion rate (OR: 2.56; p=0.005) was lower in RARP than in LRP. All the other analyzed parameters were similar, regardless of the surgical approach. RARP can be performed routinely with a relatively small risk of complications. Surgical experience, clinical patient characteristics, and cancer characteristics may affect the risk of complications. Cumulative analyses demonstrated that blood loss and transfusion rates were significantly lower with RARP than with RRP, and transfusion rates were lower with RARP than with LRP, although all other features were similar regardless of the surgical approach. Copyright © 2012. Published by Elsevier B.V.

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Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer

Ronald C Chen, Ramsankar Basak, Anne-Marie Meyer … (2017)

Importance: Patients diagnosed with localized prostate cancer have to decide among treatment strategies that may differ in their likelihood of adverse effects. Objective: To compare quality of life (QOL) after radical prostatectomy, external beam radiotherapy and brachytherapy vs. active surveillance. Design/Setting/Participants: Population-based prospective cohort of 1,141 men with newly-diagnosed prostate cancer were enrolled from January 2011 through June 2013 in collaboration with the North Carolina Central Cancer Registry (Rapid Case Ascertainment). 57% of eligible men enrolled. Median time from diagnosis to enrollment was 5 weeks, and all men were enrolled with written informed consent prior to treatment. Final follow-up date for current analysis was September 9, 2015. Exposure: Treatment – radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance. Main Outcomes and Measures: Quality of life using the validated instrument Prostate Cancer Symptom Indices was assessed at baseline (pre-treatment), and 3, 12, 24 months after treatment. The instrument contains 4 domains – sexual dysfunction, urinary obstruction and irritation, urinary incontinence, and bowel problems – each scored from 0 (no dysfunction) to 100 (maximum dysfunction). Propensity-weighted mean domain scores were compared between each treatment group vs. active surveillance at each time point. Results: 314 men pursued active surveillance (27.5%), 249 external beam radiotherapy (21.8%), 109 brachytherapy (9.6%), and 469 radical prostatectomy (41.1%). After propensity weighting, median age was 66-67 years across groups, and 77-80% were white. Propensity-weighted baseline sexual dysfunction scores were 41.8-46.4 across groups, urinary obstruction and irritation 20.8-22.8, urinary incontinence 9.7-10.5, and bowel problems 5.7-6.1. Compared to active surveillance, mean sexual dysfunction scores worsened by 3 months for radical prostatectomy (+36.2 points, 95% CI 30.4-42.0), external beam radiotherapy (+13.9, 95% CI 6.7-21.2) and brachytherapy (+17.1, 95% CI 7.8-26.6) patients. Brachytherapy (+20.5 vs. active surveillance, 95% CI 15.1-25.9) and external beam radiotherapy (+11.7, 95% CI 8.7-14.8) were associated with acute worsening of urinary obstruction and irritation, radical prostatectomy (+33.6, 95% CI 27.8-39.2) with urinary incontinence, and external beam radiotherapy (+4.9, 95% CI 2.4-7.4) bowel symptoms. By 24 months, mean scores between treatment groups vs. active surveillance were not significantly different in most domains. Conclusions and Relevance: In this cohort of men with localized prostate cancer, each treatment strategy was associated with distinct patterns of adverse effects over 2 years. These findings should be used to promote treatment decisions that incorporate individual preferences.

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Author and article information

Journal

Title: Journal of Urology

Abbreviated Title: Journal of Urology

Publisher: Elsevier BV

ISSN (Print): 0022-5347

ISSN (Electronic): 1527-3792

Publication date Created: May 2018

Publication date (Print): May 2018

Volume: 199

Issue: 5

Pages: 1210-1217

Affiliations

[1 ]Department of Urology, Wayne State University School of Medicine, Detroit, Michigan

[2 ]Department of Urology, Case Western Reserve University, Cleveland, Ohio

[3 ]Department of Urology, University of Toledo, Toledo, Ohio

[4 ]Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan

[5 ]Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan

Article

DOI: 10.1016/j.juro.2017.11.115

PubMed ID: 29225060

SO-VID: f71fe111-ca63-4d78-b773-776286926dad

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https://www.elsevier.com/tdm/userlicense/1.0/

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Functional Recovery, Oncologic Outcomes and Postoperative Complications after Robot-Assisted Radical Prostatectomy: An Evidence-Based Analysis Comparing the Retzius Sparing and Standard Approaches

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Most cited references 16

Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations.

Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy.

Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer

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