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Actas Urologicas Espanolas Apr 2007It is well known that radical prostatectomy (RP) is an excellent option in localized prostatic cancer especially from oncological control point of view. The efforts,... (Review)
Review
INTRODUCTION
It is well known that radical prostatectomy (RP) is an excellent option in localized prostatic cancer especially from oncological control point of view. The efforts, during last decades, of the urological community in this field have been addressed in trying to improve functional outcomes (urinary and sexual morbidity) after the procedure. From the beginning of this century, three managements (open, robotic and laparoscopic) have been coexisting trying to get and prove the best results. The objective of this review has been to make the most exhaustive, rigorous and objective updating with the functional and oncological outcomes from the three (RP) techniques.
MATERIAL AND METHODS
We have centered the comparison in four sections: perioperative, oncological outcomes, functional results and economic costs. With this purpose a systematic search was made in the following registers: PubMed, OVID, EMBASE and Cochrane Library, with the following terms: Retropubic RP. open RP, laparoscopic RP, robotic RP, Sexual function, urinary incontinence, quality of life, economic costs. At author's criteria, a total of 73 references were selected, that were individually analyzed.
RESULTS
Whatever the technique is, the mortality related to the procedure is extremely low, with little postoperative pain and minimum analgesic requirements. The oncological results are similar, measured in surgical margin terms: Open RP (14-20%), Laparoscopic RP (7.4-21.9%) and robotic RP (5.7-17.3%). Concerning functional results (sexual function and urinary continence), it is difficult to establish comparisons due to the multitude of existing byas (non randomized studies, different methods and measurement scales, different definitions, etc.) In the uni-insitutional studies, results seem to be equivalent.
CONCLUSIONS
Laparoscopic and robotic RP series are still pending of mature outcomes, related to long term biochemical control and functional results. It seems that with these managements, blood loss and transfusion needs are minor compared to open surgery. Robotic technology adds very interesting advantages that could have an important role in homogenize the minimally invasive management, but are still pending of validation at medium and long term.
Topics: Costs and Cost Analysis; Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 17633916
DOI: 10.1016/s0210-4806(07)73644-6 -
Ontario Health Technology Assessment... 2017Prostate cancer is the second most common type of cancer in Canadian men. Radical prostatectomy is one of the treatment options available, and involves removing the... (Review)
Review
BACKGROUND
Prostate cancer is the second most common type of cancer in Canadian men. Radical prostatectomy is one of the treatment options available, and involves removing the prostate gland and surrounding tissues. In recent years, surgeons have begun to use robot-assisted radical prostatectomy more frequently. We aimed to determine the clinical benefits and harms of the robotic surgical system for radical prostatectomy (robot-assisted radical prostatectomy) compared with the open and laparoscopic surgical methods. We also assessed the cost-effectiveness of robot-assisted versus open radical prostatectomy in patients with clinically localized prostate cancer in Ontario.
METHODS
We performed a literature search and included prospective comparative studies that examined robot-assisted versus open or laparoscopic radical prostatectomy for prostate cancer. The outcomes of interest were perioperative, functional, and oncological. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also conducted a cost-utility analysis with a 1-year time horizon. The potential long-term benefits of robot-assisted radical prostatectomy for functional and oncological outcomes were also evaluated in a 10-year Markov model in scenario analyses. In addition, we conducted a budget impact analysis to estimate the additional costs to the provincial budget if the adoption of robot-assisted radical prostatectomy were to increase in the next 5 years. A needs assessment determined that the published literature on patient perspectives was relatively well developed, and that direct patient engagement would add relatively little new information.
RESULTS
Compared with the open approach, we found robot-assisted radical prostatectomy reduced length of stay and blood loss (moderate quality evidence) but had no difference or inconclusive results for functional and oncological outcomes (low to moderate quality evidence). Compared with laparoscopic radical prostatectomy, robot-assisted radical prostatectomy had no difference in perioperative, functional, and oncological outcomes (low to moderate quality evidence). Compared with open radical prostatectomy, our best estimates suggested that robot-assisted prostatectomy was associated with higher costs ($6,234) and a small gain in quality-adjusted life-years (QALYs) (0.0012). The best estimate of the incremental cost-effectiveness ratio (ICER) was $5.2 million per QALY gained. However, if robot-assisted radical prostatectomy were assumed to have substantially better long-term functional and oncological outcomes, the ICER might be as low as $83,921 per QALY gained. We estimated the annual budget impact to be $0.8 million to $3.4 million over the next 5 years.
CONCLUSIONS
There is no high-quality evidence that robot-assisted radical prostatectomy improves functional and oncological outcomes compared with open and laparoscopic approaches. However, compared with open radical prostatectomy, the costs of using the robotic system are relatively large while the health benefits are relatively small.
Topics: Cost-Benefit Analysis; Humans; Male; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Quality-Adjusted Life Years; Robotic Surgical Procedures; Technology Assessment, Biomedical
PubMed: 28744334
DOI: No ID Found -
Gan To Kagaku Ryoho. Cancer &... Dec 2011We have 3 options when perfoming prostatectomy for the treatment of localized prostate cancer. Those are retropubic radical prostatectomy, laparoscopic radical... (Review)
Review
We have 3 options when perfoming prostatectomy for the treatment of localized prostate cancer. Those are retropubic radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy. We compared the characteristics and results of these techniques. Robot-assisted laparoscopic radical prostatectomy could be superior to the others in many ways. However, it would be very difficult to adopt it in Japan because it would pose economical difficulties. The administrative assistance in the insurance systems requireds much more than we have.
Topics: Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Robotics; Treatment Outcome
PubMed: 22189218
DOI: No ID Found -
Archivos Espanoles de Urologia Sep 2007Radical prostatectomy is worldwide accepted as treatment for clinically localized prostate cancer. Its oncological results are excellent, so nowadays the functional... (Comparative Study)
Comparative Study Review
OBJECTIVES
Radical prostatectomy is worldwide accepted as treatment for clinically localized prostate cancer. Its oncological results are excellent, so nowadays the functional outcomes: continence and potency, have become essential factors when evaluating the results. Open radical prostatectomy (ORP) is the gold standard against the new techniques, Laparoscopic (LRP) and robotic (RRP) must be compared. A systematic review of the literature is done to evaluate functional outcomes between the three approaches.
METHODS
Systematic review in the databases: PubMed; EMBASE; Cochrane; SCOPUS; Science Citation Index for: "radical retropubic prostatectomy", "open radical prostatectomy"; "laparoscopic prostatectomy"; "laparoscopic radical prostatectomy"; "robotic prostatectomy"; "robotic radical prostatectomy and functional assessment"; "continence"; "urinary function"; "incontinence"; "erectile function"; 'sexual function"; "quality of life"; "functional assessment"; "minimally invasive treatment was performed".
RESULTS
The lack of randomized trials for this issue forces us to evaluate the functional results comparing the most important series of each approach, so the value of the results are very limited. Accepting 0 pads per day as continence definition and evaluated 12 months following surgery, the continence rates for each approach ORP, LRP and RRP are respectively: 8 1% (60-93%); 87% (82-95%) and 91% (84-98%). For erectile function admitting the capability for intercourse as potency definition, with or without the use of oral drugs and evaluated 12 months following surgery; the potency rates for each approach are: 68% (62-75%), 69% (52-78%) y 60% (20-97%).
CONCLUSIONS
Due the lack of randomized trials, we have to evaluate the most important contemporaneous series. The lack of homogeneity in evaluating and reporting results is evident in the urological community. With the limitations of the data available it seems to exist no differences between the three groups for functional outcomes. It is mandatory to develop randomized trials and achieve a consensus for the criteria at the time of evaluating the functional outcomes.
Topics: Erectile Dysfunction; Humans; Laparoscopy; Male; Prostatectomy; Robotics; Urinary Incontinence
PubMed: 17937336
DOI: 10.4321/s0004-06142007000700006 -
Urologia Internationalis 2013The best technique of radical prostatectomy - open versus robot-assisted approach - is controversially discussed. In this study, we compared the complication rates of...
BACKGROUND
The best technique of radical prostatectomy - open versus robot-assisted approach - is controversially discussed. In this study, we compared the complication rates of open and robot-assisted radical prostatectomy during the introduction and subsequent routine use of a da Vinci® robotic device while open surgery remained the standard approach.
PATIENTS AND METHODS
Between January 1st, 2006, and June 4th, 2012, 2,754 men underwent radical prostatectomy at our department. Among them, 317 received robot-assisted and 2,438 open surgery. According to the requirements for prostate cancer centers certified by the Deutsche Krebsgesellschaft (German Cancer Society), a prospective database recording perioperative complications was built up. The complication rates of open and robot-assisted radical prostatectomy were compared with the χ(2) or Fisher exact test. The distributions of quantitative variables were compared with U tests.
RESULTS
Whereas the demographic factors favored patients selected for robot-assisted radical prostatectomy, there were no differences between open and robot-assisted surgery concerning length of stay, autologous blood transfusion rates and the incidence of perioperative complications.
CONCLUSIONS
Open and robot-assisted radical prostatectomy had comparable complication rates. With better patient- and tumor-related parameters as well as decreasing transfusion rates in the robot-assisted subgroup, this observation might reflect the learning curves of the involved robotic surgeons.
Topics: Aged; Blood Transfusion; Chi-Square Distribution; Clinical Competence; Equipment Design; Humans; Laparoscopy; Learning Curve; Length of Stay; Lymphocele; Male; Middle Aged; Postoperative Complications; Postoperative Hemorrhage; Prostatectomy; Robotics; Surgery, Computer-Assisted; Surgical Equipment; Time Factors; Treatment Outcome
PubMed: 23485928
DOI: 10.1159/000345323 -
Korean Journal of Urology Feb 2015We sought to evaluate the feasibility and safety of open or robotic radical prostatectomy (RP) after rectum, sigmoid, or colon surgery.
PURPOSE
We sought to evaluate the feasibility and safety of open or robotic radical prostatectomy (RP) after rectum, sigmoid, or colon surgery.
MATERIALS AND METHODS
Sixty-four patients with a median age of 65 years (range, 46-73 years) who underwent RP after previous pelvic surgery were included. Twenty-four patients (38%) underwent robotic RP and 40 patients (62%) underwent open RP. Bilateral lymph node dissection and nerve preservation were performed in 50 patients (78%) and 35 patients (55%), respectively. Variables evaluated included demographic characteristics, perioperative complications, and functional and oncological outcomes. The median hospitalization and follow-up periods were 2 days (range, 1-12 days) and 21 months (range, 1-108 months), respectively.
RESULTS
No conversions from robotic to open surgery were performed and there were no intraoperative complications. Surgical margins were positive in 13 patients (20%), seminal vesicle involvement was detected in 6 patients (9%), and lymph node involvement was found in 2 patients (3%). Postoperative complications included lymphocele in 1 patient, urethral stricture in 1 patient, and bowel obstruction and persistent bladder leakage in 2 patients. Eighty-eight percent of the patients were continent at 7 months and 80% of patients were able to achieve erection with or without medical aid.
CONCLUSIONS
Open or robotic RP can be done safely and effectively in patients who have previously undergone pelvic surgery. Although prior pelvic surgery of the large intestine was associated with increased morbidity, it should not be considered a contraindication for robotic or open RP.
Topics: Aged; Feasibility Studies; Humans; Intestine, Large; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Treatment Outcome
PubMed: 25685300
DOI: 10.4111/kju.2015.56.2.131 -
Current Urology Reports Jun 2016Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms (LUTS) in aging men. Over the age of 60, more than a half of men have... (Review)
Review
Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms (LUTS) in aging men. Over the age of 60, more than a half of men have BPH and/or bothersome LUTS. Contemporary guidelines advocate surgery as the standard of care for symptomatic BPH after failure of medical therapy, where the choice of the appropriate surgical procedure depends on the prostate size. Transurethral resection of the prostate (TURP) and simple open prostatectomy (OP) have been considered for decades the reference-standard techniques for men with prostate smaller and larger than 80 ml, respectively. However, both procedures are potentially associated with considerable perioperative morbidity which prompted the introduction of a variety of minimally invasive surgical techniques with comparable long-term outcomes compared to TURP and OP. Nevertheless, the management of prostates larger than 100 ml remains a clinical challenge. Transurethral anatomical enucleation of the prostate utilizing different laser energy represents an excellent alternative concept in transurethral BPH surgery. These procedures gained popularity and demonstrated similar outcomes to OP with the advantages of favorable morbidity profiles and shorter catheter time and hospital stay. Despite the fact that OP remains a viable treatment option for patients with bothersome LUTS secondary to very large prostates, this procedure has been to a large extent replaced by these emerging enucleation techniques. Given the advent of surgical alternatives, the current review presents an evidence-based comparison of the efficacy and safety profile of the currently available transurethral laser techniques with the standard OP for the management of BPH due to adenomas larger than 100 ml.
Topics: Humans; Laser Therapy; Length of Stay; Male; Minimally Invasive Surgical Procedures; Prostatectomy; Prostatic Hyperplasia; Transurethral Resection of Prostate
PubMed: 27048160
DOI: 10.1007/s11934-016-0601-7 -
World Journal of Urology Apr 2007The treatment of prostate cancer has undergone a fundamental change in the last decade. New surgical and nonsurgical minimal invasive methods have evolved. As the... (Review)
Review
The treatment of prostate cancer has undergone a fundamental change in the last decade. New surgical and nonsurgical minimal invasive methods have evolved. As the methodology of the different treatments is commonly known to urologists, this article focuses on oncological and functional outcome of open retropubic (ORP), trans- or extraperitoneal endoscopical (LRP), and robot-assisted radical prostatectomy (RALP), based on personal experience and review of the literature. A MEDLINE search was performed to review the literature on LRP and RALP between 1982 and 2007 with special emphasis on oncological and functional results, technical considerations, comparison of LRP and RALP to ORP, laparoscopic training, historical aspects, and cost-efficiency of the techniques. Based on diligent training and proctoring programs, a continuous dissemination of laparoscopic techniques takes place. There is a trend towards the extraperitoneal access in most of the minimal invasive programs at least in the European community. Mid-term outcomes of LRP and short-term outcomes of RALP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower transfusion rates, shorter convalescence, and better cosmetics. In contrast to RALP, LRP reaches cost-equivalence with open surgery in selected centers. LRP and RALP reproduce the short-term results of open surgery while providing the advantages of a minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow, but the discussion about the longer learning curve for laparoscopy handling remains. The future will show if European centers adopt the use of robots comparable to the United States.
Topics: Clinical Competence; Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Robotics; Treatment Outcome
PubMed: 17354014
DOI: 10.1007/s00345-007-0164-9 -
Expert Review of Anticancer Therapy Jul 2009
Topics: Humans; Laparoscopy; Male; Minimally Invasive Surgical Procedures; Prostatectomy; Prostatic Neoplasms; Robotics; Treatment Outcome; United States
PubMed: 19589023
DOI: 10.1586/era.09.65 -
Urologic Oncology 2007The optimal outcome of radical prostatectomy is to cure cancer with the least impact on quality of life. The aim of this paper is to review the existent literature and... (Comparative Study)
Comparative Study Review
INTRODUCTION
The optimal outcome of radical prostatectomy is to cure cancer with the least impact on quality of life. The aim of this paper is to review the existent literature and attempt to compare the results of the retropubic (RRP) with the laparoscopic (LRP) approach.
METHODOLOGY
Extensive Medline literature search for terms "radical retropubic prostatectomy" and "laparoscopic radical prostatectomy" from 1980 to 2006 to compare cancer control, functional outcomes and morbidity for both groups. Only full length English language articles including 100 or more patients were considered.
RESULTS
The 5-year biochemical recurrence rates range from 70-92% for the RRP vs. 82-91% for the LRP. The global positive surgical margin rates are 12-20% for the RRP and 17-30% for the LRP. The continence rate for the RRP varies from 70-93%; the LRP varies from 82-95% for 12 months. Considering potency 12 months after surgery, the rates are 17-75% for the RRP vs. 52-78% for the LRP. The blood loss for the RRP ranges from 818 to 1,500 ml and 220 to 1,100 for the LRP.
CONCLUSIONS
The concurrent literature lacks randomized trials comparing the different surgical techniques. No definitive conclusions can be drawn.
Topics: Humans; Laparoscopy; Male; Neoplasm Recurrence, Local; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Treatment Outcome
PubMed: 18047960
DOI: 10.1016/j.urolonc.2007.05.020