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Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial.
Eur Urol Oncol. 2018 10; 1(5):353-360.EU

Abstract

BACKGROUND

The adoption of robot-assisted laparoscopic radical prostatectomy (RALP) has increased rapidly, despite lack of conclusive evidence of its superiority regarding long-term outcomes over open retropubic RP (RRP). In 2015, we reported on 12-mo follow-up from the LAPPRO trial showing a moderate advantage of RALP regarding erectile dysfunction. No significant differences were seen for urinary incontinence or surgical margin status.

OBJECTIVE

To present patient-reported functional outcomes and recurrent and residual disease at 24-mo follow-up from the prospective multicenter LAPPRO trial.

DESIGN, SETTING, AND PARTICIPANTS

A total of 4003 patients with clinically localized prostate cancer were recruited from 14 Swedish centers, seven performing RALP and seven RRP.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Data were only analyzed for patients operated on by surgeons with >100 prior RPs. Adjusted odds ratios (AORs) were calculated using logistic regression, with adjustment for differences in patient mix.

RESULTS AND LIMITATIONS

At 24 mo, there was a significant difference in erectile dysfunction in favor of RALP (68% vs 74%; AOR 0.72, 95% confidence interval [CI] 0.57-0.91; p=0.006). No significant difference was observed for incontinence (19% vs 16%; AOR 1.29, 95% CI 1.00-1.67; p=0.053) or recurrent or residual disease (13% vs 13%; AOR 0.79, 95% CI 0.59-1.07; p=0.13). We did not adjust for individual surgeon volume and experience, which is a potential limitation.

CONCLUSIONS

Extended follow-up corroborated our previous report at 12 mo of a persistent RALP benefit regarding potency.

PATIENT SUMMARY

LAPPRO is a Swedish trial comparing two different prostate cancer surgical techniques (robotic compared to open). At 24-mo follow-up after surgery there was a moderate advantage for the robotic technique regarding erectile dysfunction (potency), while there was a small but not significant difference in urinary leakage in favor of open surgery. We did not find any difference regarding cancer relapse.

Authors+Show Affiliations

Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Division of Urological Cancers, Faculty of Medicine, Lund University, Sweden.Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden.Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.Department of Surgery, Institute of Clinical Sciences, Scandinavian Surgical Outcomes Research Group, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Division of Urological Cancers, Faculty of Medicine, Lund University, Sweden. Electronic address: anders.bjartell@med.lu.se.No affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31158073

Citation

Nyberg, Martin, et al. "Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial." European Urology Oncology, vol. 1, no. 5, 2018, pp. 353-360.
Nyberg M, Hugosson J, Wiklund P, et al. Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial. Eur Urol Oncol. 2018;1(5):353-360.
Nyberg, M., Hugosson, J., Wiklund, P., Sjoberg, D., Wilderäng, U., Carlsson, S. V., Carlsson, S., Stranne, J., Steineck, G., Haglind, E., & Bjartell, A. (2018). Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial. European Urology Oncology, 1(5), 353-360. https://doi.org/10.1016/j.euo.2018.04.012
Nyberg M, et al. Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial. Eur Urol Oncol. 2018;1(5):353-360. PubMed PMID: 31158073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial. AU - Nyberg,Martin, AU - Hugosson,Jonas, AU - Wiklund,Peter, AU - Sjoberg,Daniel, AU - Wilderäng,Ulrica, AU - Carlsson,Sigrid V, AU - Carlsson,Stefan, AU - Stranne,Johan, AU - Steineck,Gunnar, AU - Haglind,Eva, AU - Bjartell,Anders, AU - ,, Y1 - 2018/06/11/ PY - 2018/03/09/received PY - 2018/04/06/revised PY - 2018/04/16/accepted PY - 2019/6/4/entrez PY - 2019/6/4/pubmed PY - 2019/10/23/medline KW - Biochemical recurrence KW - Erectile dysfunction KW - Open radical prostatectomy KW - Prostate cancer KW - Robot-assisted laparoscopic radical prostatectomy KW - Urinary incontinence SP - 353 EP - 360 JF - European urology oncology JO - Eur Urol Oncol VL - 1 IS - 5 N2 - BACKGROUND: The adoption of robot-assisted laparoscopic radical prostatectomy (RALP) has increased rapidly, despite lack of conclusive evidence of its superiority regarding long-term outcomes over open retropubic RP (RRP). In 2015, we reported on 12-mo follow-up from the LAPPRO trial showing a moderate advantage of RALP regarding erectile dysfunction. No significant differences were seen for urinary incontinence or surgical margin status. OBJECTIVE: To present patient-reported functional outcomes and recurrent and residual disease at 24-mo follow-up from the prospective multicenter LAPPRO trial. DESIGN, SETTING, AND PARTICIPANTS: A total of 4003 patients with clinically localized prostate cancer were recruited from 14 Swedish centers, seven performing RALP and seven RRP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Data were only analyzed for patients operated on by surgeons with >100 prior RPs. Adjusted odds ratios (AORs) were calculated using logistic regression, with adjustment for differences in patient mix. RESULTS AND LIMITATIONS: At 24 mo, there was a significant difference in erectile dysfunction in favor of RALP (68% vs 74%; AOR 0.72, 95% confidence interval [CI] 0.57-0.91; p=0.006). No significant difference was observed for incontinence (19% vs 16%; AOR 1.29, 95% CI 1.00-1.67; p=0.053) or recurrent or residual disease (13% vs 13%; AOR 0.79, 95% CI 0.59-1.07; p=0.13). We did not adjust for individual surgeon volume and experience, which is a potential limitation. CONCLUSIONS: Extended follow-up corroborated our previous report at 12 mo of a persistent RALP benefit regarding potency. PATIENT SUMMARY: LAPPRO is a Swedish trial comparing two different prostate cancer surgical techniques (robotic compared to open). At 24-mo follow-up after surgery there was a moderate advantage for the robotic technique regarding erectile dysfunction (potency), while there was a small but not significant difference in urinary leakage in favor of open surgery. We did not find any difference regarding cancer relapse. SN - 2588-9311 UR - https://www.unboundmedicine.com/medline/citation/31158073/Functional_and_Oncologic_Outcomes_Between_Open_and_Robotic_Radical_Prostatectomy_at_24_month_Follow_up_in_the_Swedish_LAPPRO_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2588-9311(18)30039-7 DB - PRIME DP - Unbound Medicine ER -