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Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial.
Eur Urol. 2018 04; 73(4):618-627.EU

Abstract

BACKGROUND

Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable.

OBJECTIVE

To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping.

DESIGN, SETTING, AND PARTICIPANTS

In a prospective nonrandomised trial, we recruited 2545 men with prostate cancer from seven open (n=753) and seven robot-assisted (n=1792) Swedish centres (2008-2011).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Clinometrically-validated questionnaire-based patient-reported erectile function was collected before, 3 mo, 12 mo, and 24 mo after surgery. Surgeon-reported degree of neurovascular-bundle preservation, pathologist-reported positive surgical margin (PSM) rates, and 2-yr prostate-specific antigen-relapse rates were measured.

RESULTS AND LIMITATIONS

Among 1702 preoperatively potent men, we found enhanced erectile function recovery for low/intermediate-risk patients in the robot-assisted group at 3 mo. For patients with high-risk tumours, point estimates for erectile function recovery at 24 mo favoured the open surgery group. The degree of neurovascular bundle preservation and erectile function recovery were greater correlated for robot-assisted surgery. In pT2 tumours, 10% versus 17% PSM rates were observed for open and robot-assisted surgery, respectively; corresponding rates for pT3 tumours were 48% and 33%. These differences were associated with biochemical recurrence in pT3 but not pT2 disease. The study is limited by its nonrandomised design and relatively short follow-up.

CONCLUSIONS

Earlier recovery of erectile function in the robot-assisted surgery group in lower-risk patients is counterbalanced by lower PSM rates for open surgeons in organ-confined disease; thus, both open and robotic surgeons need to consider this trade-off when determining the plane of surgical dissection. Robot-assisted surgery also facilitates easier identification of nerve preservation planes during radical prostatectomy as well as wider dissection for pT3 cases.

PATIENT SUMMARY

For prostate cancer surgery, an open operation reduces erection problems in high-risk cancers but has higher relapse rates than robotic surgery. Relapse rates appear similar in low/intermediate-risk cancers and the robot appears better at preserving erections in these cases.

Authors+Show Affiliations

Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Uro-oncology, University College London Hospital NHS Foundation Trust. Electronic address: sooriakumaran@gmail.com.Department of Urology, San Raffaele Turro Hospital, Milan, Italy.Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.Department of Urology, Sahlgrenska Academy, Gothenburg, Sweden.Faculty of Medicine, Lund University, Lund, Sweden.Department of Urology, Sahlgrenska Academy, Gothenburg, Sweden.Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Department of Oncology, Sahlgrenska Academy, Gothenburg, Sweden.Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28882327

Citation

Sooriakumaran, Prasanna, et al. "Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results From the LAParoscopic Prostatectomy Robot Open Trial." European Urology, vol. 73, no. 4, 2018, pp. 618-627.
Sooriakumaran P, Pini G, Nyberg T, et al. Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial. Eur Urol. 2018;73(4):618-627.
Sooriakumaran, P., Pini, G., Nyberg, T., Derogar, M., Carlsson, S., Stranne, J., Bjartell, A., Hugosson, J., Steineck, G., & Wiklund, P. N. (2018). Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial. European Urology, 73(4), 618-627. https://doi.org/10.1016/j.eururo.2017.08.015
Sooriakumaran P, et al. Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results From the LAParoscopic Prostatectomy Robot Open Trial. Eur Urol. 2018;73(4):618-627. PubMed PMID: 28882327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial. AU - Sooriakumaran,Prasanna, AU - Pini,Giovannalberto, AU - Nyberg,Tommy, AU - Derogar,Maryam, AU - Carlsson,Stefan, AU - Stranne,Johan, AU - Bjartell,Anders, AU - Hugosson,Jonas, AU - Steineck,Gunnar, AU - Wiklund,Peter N, Y1 - 2017/09/04/ PY - 2017/01/16/received PY - 2017/08/20/accepted PY - 2017/9/9/pubmed PY - 2019/1/29/medline PY - 2017/9/9/entrez KW - Erectile function KW - Radical prostatectomy KW - Retropubic KW - Robotic assisted SP - 618 EP - 627 JF - European urology JO - Eur. Urol. VL - 73 IS - 4 N2 - BACKGROUND: Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable. OBJECTIVE: To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping. DESIGN, SETTING, AND PARTICIPANTS: In a prospective nonrandomised trial, we recruited 2545 men with prostate cancer from seven open (n=753) and seven robot-assisted (n=1792) Swedish centres (2008-2011). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Clinometrically-validated questionnaire-based patient-reported erectile function was collected before, 3 mo, 12 mo, and 24 mo after surgery. Surgeon-reported degree of neurovascular-bundle preservation, pathologist-reported positive surgical margin (PSM) rates, and 2-yr prostate-specific antigen-relapse rates were measured. RESULTS AND LIMITATIONS: Among 1702 preoperatively potent men, we found enhanced erectile function recovery for low/intermediate-risk patients in the robot-assisted group at 3 mo. For patients with high-risk tumours, point estimates for erectile function recovery at 24 mo favoured the open surgery group. The degree of neurovascular bundle preservation and erectile function recovery were greater correlated for robot-assisted surgery. In pT2 tumours, 10% versus 17% PSM rates were observed for open and robot-assisted surgery, respectively; corresponding rates for pT3 tumours were 48% and 33%. These differences were associated with biochemical recurrence in pT3 but not pT2 disease. The study is limited by its nonrandomised design and relatively short follow-up. CONCLUSIONS: Earlier recovery of erectile function in the robot-assisted surgery group in lower-risk patients is counterbalanced by lower PSM rates for open surgeons in organ-confined disease; thus, both open and robotic surgeons need to consider this trade-off when determining the plane of surgical dissection. Robot-assisted surgery also facilitates easier identification of nerve preservation planes during radical prostatectomy as well as wider dissection for pT3 cases. PATIENT SUMMARY: For prostate cancer surgery, an open operation reduces erection problems in high-risk cancers but has higher relapse rates than robotic surgery. Relapse rates appear similar in low/intermediate-risk cancers and the robot appears better at preserving erections in these cases. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/28882327/Erectile_Function_and_Oncologic_Outcomes_Following_Open_Retropubic_and_Robot_assisted_Radical_Prostatectomy:_Results_from_the_LAParoscopic_Prostatectomy_Robot_Open_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(17)30708-X DB - PRIME DP - Unbound Medicine ER -