Early assessment of patient satisfaction and health-related quality of life following robot-assisted radical prostatectomy

Impairments in health-related quality of life (HRQOL) and patient satisfaction after definitive treatment for localized prostate cancer can be significant. We assessed patient satisfaction associated with HRQOL following robot-assisted radical prostatectomy (RARP). Prostate cancer-specific HRQOL was assessed using 50 items from the Expanded Prostate Cancer Index Composite and postoperative satisfaction parameters. According to the satisfaction level, 218 consecutive patients were divided into the following three groups: group 1, extremely satisfied (n = 140); group 2, satisfied (n = 54); and group 3, uncertain, dissatisfied and extremely dissatisfied patients (n = 24). Peri-operative characteristics were not significantly different among the three groups. When the mean domain-specific HRQOL subscale scores were compared, there were no statistical differences in urinary and sexual function between groups 1 and 2. Patients in group 2 were more bothered by these domains than those in group 1. Group 3 had significantly lower scores in bowel and hormonal bother than the other groups and significantly lower scores in bowel function when compared to group 1. In daily life related to HRQOL, satisfaction is mainly determined by personal perception and interpretation rather than the objective status of urinary and sexual function. More interestingly, patients in the dissatisfied group were more likely to have bladder and bowel storage symptoms. Additional work is necessary to identify the factors associated with increased risk of pelvic organ storage symptoms following RARP.     

Health-related quality of life after radical prostatectomy in Japanese men with localized prostate cancer

PURPOSE: We evaluated retrospectively health-related quality of life (HRQOL) after radical prostatectomy (RP) in Japanese men with localized prostate cancer. METHODS: The study was based on self-reported HRQOL of 280 patients. Patients were divided into seven groups: time 0 (T0), baseline before operation; T1, 1-3 months after RP; T2, 4-6 months after RP; T3, 7-12 months after RP; T4, 13-24 months after RP; T5, 25-36 months after RP; and T6, more than 36 months after RP. We measured the general and disease-specific HRQOL using the RAND 36-item Health Survey 1.0 (SF-36) and the University of California, Los Angeles Prostate Cancer Index (UCLA PCI). RESULTS: The general HRQOL of the postoperative groups was assessed by SF-36. The postoperative groups showed almost the same or higher scores than those of the baseline group. Urinary function scores decreased substantially after surgery. In contrast, there was no difference in urinary bother between the baseline and postoperative groups. Sexual function deteriorated substantially in all postoperative groups. Similarly, the sexual bother score significantly deteriorated after RP. The sexual bother score of men aged 65-years or younger was significantly worse than that of their counterparts in the T1-2 groups. CONCLUSION: Despite reports of problems with sexual activity and urinary continence, general HRQOL was mostly unaffected by RP. Although there was a substantial decrease in urinary function, recovery from urinary bother was rapid. Since the deterioration of sexual function was marked through the postoperative period, careful attention should be paid to this issue during preoperative counseling, especially for younger patients.     

Patient-reported quality of life after radical prostatectomy for prostate cancer

BACKGROUND: Increasingly, quality of life (QOL) assessments are receiving greater attention in the management of malignancies, including prostate cancer. We evaluated the impact of radical prostatectomy on patient QOL 12 months or longer after surgery. PATIENTS AND METHODS: We evaluated the impact of radical prostatectomy on QOL in 60 patients with prostate cancer. The patients comprised two groups: the first group (n = 32) was evaluated 12 months or longer after radical prostatectomy; the second group (n = 28) was evaluated while awaiting radical prostatectomy. General health-related QOL was measured with the European Organization for Research and Treatment of Cancer Prostate Cancer QOL Questionnaire. Sexual function was assessed with the Sapporo Medical University Sexual Function Questionnaire. A newly developed instrument assessing urinary function was prepared only for the postoperative group. RESULTS: No differences between the two groups were seen in comparisons of general health-related QOL subscales. Men who underwent surgery reported significant deterioration in sexual function (decreased quality of erection, decreased sexual activity and decreased satisfaction with sex life) than those awaiting surgery. Of the 32 postoperative patients, 26 (81%) did not use pads at all, five (16%) used one or fewer pads per day due to occasional spotting and only one patient (3%) used two to four pads per day to deal with urine dripping. Twenty-six postoperative patients (81%) stated that, given the choice, they would undergo radical prostatectomy again. CONCLUSIONS: General health-related QOL does not appear to be compromised following radical prostatectomy. Patients are willing to accept some morbidity for a perceived survival benefit. Although minimal urinary dysfunction was reported, most patients were dissatisfied with postoperative sexual function. In preoperative counselling, greater emphasis should be placed on the risk of postoperative impotence.     

经腹途径与经腹膜外途径机器人辅助腹腔镜下根治性前列腺切除术临床疗效的Meta分析

目的:采用Meta分析的方法比较经腹途径机器人辅助腹腔镜下根治性前列腺切除术(Tp-RALRP)与经腹膜外途径机器人辅助腹腔镜下根治性前列腺切除术(Ep-RALRP)治疗局限性前列腺癌的临床疗效。方法:通过计算机检索Pubmed,EMBASE,Web of science,EBSCO,Cochrane library,万方,中国知网(CNKI),中国生物医学数据库(CBM)(2000年1月~2016年11月),入选文献必须对比Tp-RALRP与Ep-RALRP的疗效,包含手术时间、术中出血量、术后留置导尿时间、术后卧床时间、围手术期并发症发生率、切缘阳性率、与肠道有关的并发症发生率、术后尿道吻合口瘘发生率、术后控尿率等指标中的至少一项,运用Meta分析方法比较两种手术方式在治疗局限性前列腺癌疗效上的差异。统计学软件采用Rev Man 5.3软件。结果:经仔细筛选后共有8篇文献纳入该研究,其中Tp-RALRP组451例,Ep-RALRP组676例。与Tp-RALRP相比,Ep-RALRP具有手术时间短(WMD=21.39,95%CI 7.54~35.24,P=0.002),术后卧床时间短(WMD=0.85,95%CI 0.61~1.09,P0.001)、与肠道有关的并发症发生率低(RR=9.74,95%CI 3.26~29.07,P0.001)等优势,差异均有统计学意义(P0.05)。两种手术方式的术中出血量(WMD=-8.12,95%CI-27.86~11.63,P=0.42)、术后留置导尿时间(WMD=-0.17,95%CI-0.55~0.21,P=0.38)、围手术期并发症发生率(RR=1.34,95%CI-0.97~1.87,P=0.08)、切缘阳性率(RR=1.24,95%CI 0.95~1.61,P=0.12)、术后尿道吻合口瘘发生率(RR=0.98,95%CI 0.46~2.10,P=0.95)、术后3个月控尿率(RR=0.96,95%CI 0.91~1.00,P=0.05)及术后6个月控尿率(RR=1.00,95%CI 0.97~1.02,P=0.82)等方面差异均无统计学意义(P0.05)。结论:与Tp-RALRP相比,Ep-RALRP具有手术时间短、术后卧床时间短、与肠道有关的并发症发生率低等优点,因此,Ep-RLRP可能是治疗局限性前列腺癌更好的方法。但未来仍然需要开展更多多中心、大样本的随机对照研究进而更好地评估两种手术方式的优劣。     

Impact of prostate size in robot-assisted radical prostatectomy

BACKGROUND AND PURPOSE: A large prostate can complicate an extraperitoneal robot-assisted radical prostatectomy (RARP). We report our experience with RARP and evaluate the effects of prostate size on treatment outcomes after extraperitoneal RARP. PATIENTS AND METHODS: Information on 355 consecutive patients undergoing extraperitoneal RARP was gathered, and patients with prostate weight <75 g (N = 319) were compared with those having glands >or=75 g (N = 36). The factors considered were age, body mass index, total operating time, estimated blood loss, serum prostate specific antigen (PSA) concentration, pathologic stage and Gleason grade, intraoperative and peri-operative complications, margin status, and continence. RESULTS: A statistically significant difference (P < 0.05) was noted in age (59 v 64 years), PSA concentration (6.07 v 8.9 ng/dL), and blood loss (175 v 226 mL) between patients with smaller v larger prostates. No difference was seen in Gleason score (6 v 6), clinical T stage, operative time (217 v 225 minutes), or total positive-margin rate (13% v 19%). A higher positive-margin rate was seen in patients with stage T(3) disease and larger prostates. The 6-month continence rate in patients with a prostate volume < 75 g was 97% v 84% in patients with larger prostate volumes ( P < 0.05). CONCLUSION: Although a large prostate volume is associated with a slight increase in short-term urinary complications postoperatively, it should not be considered a contraindication for the experienced surgeon. This higher risk raises the question of a possible need for longer catheterization in this subset of patients.     

Urodynamic changes in patients with prostate cancer undergoing robotic-assisted radical prostatectomy: A comparison with laparoscopic radical prostatectomy

ObjectiveThis study investigated the urinary incontinence status and urodynamic changes of localized prostate cancer patients after laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RaRP).Materials and methodsWe enrolled 36 and 30 patients who underwent LRP and RaRP, respectively. The urinary incontinence status and videourodynamic studies (VUDS) of the LRP and RaRP groups during the first year after the surgery were compared.ResultsThe RaRP group was younger and had a smaller prostate volume, shorter operation time, less blood loss, and higher proportion of patients who received postoperative radiotherapy than the LRP group. Twenty RaRP and 26 LRP patients completed VUDS during the 1-year follow-up. Overall, reduced detrusor voiding pressure (Pdet), increased maximal urinary flow rate (Qmax), and reduced bladder outlet obstruction index (BOOI) were detected at 3, 6, and 12 months postoperatively. At 12 months, both the LRP and RaRP groups had similar significant reductions of Pdet. However, only the RaRP group had a significant increase of Qmax and significant reduction of BOOI. Overall, 56.5% of patients (26 of 46) had detrusor overactivity (DO) before the surgery. The de novo DO rate and DO remission rate were 15.2% and 19.6%, respectively, without significant difference between the LRP and RaRP groups. At 6 months, the RaRP group had a significantly lower rate of stress urinary incontinence (SUI) than the LRP group (4.5% versus 47.2%, p = 0.003). In the RaRP group, the greater degree of recovery of both stress and urgency urinary continence developed during the first 6 months postoperatively.ConclusionThe changes of VUDS at 12 months postoperatively for radical prostatectomy included reduced Pdet and BOOI, and increased Qmax. At 6 months, the RaRP group had a lower SUI rate then the LRP group. The key phase of urinary continence recovery was the first 6 months after the surgery.     

Health related quality of life in Japanese men after radical prostatectomy or radiation therapy for localized prostate cancer

BACKGROUND: We performed a retrospective survey of general and disease specific health-related quality of life (HRQOL) after radical prostatectomy (RP) and external beam radiotherapy (XRT) in Japanese men. METHODS: A total of 186 patients underwent RP and 78 underwent XRT for clinically localized prostate cancer between 2000 and 2002. We measured the general and disease specific HRQOL with the MOS 36-Item Health Survey and the University of California, Los Angeles Prostate Cancer Index, respectively. Each treatment group was further divided into four subgroups according to the time scale. RESULTS: Patients from the RP group were significantly younger than those from the XRT group. The tumor characteristics differed significantly in their distributions among the treatment groups. Patients undergoing XRT had low scores in most of the general measures of HRQOL just after treatment, but after 6 months there were no differences between the treatment groups, except for the physical domains. The RP group was associated with worse urinary function, whereas the XRT group had worse bowel function and bother during the first 6 months after treatment. Thereafter, however, urinary and bowel domain did not differ between the groups. Both groups reported poor sexual function, although the RP group scored lower sexual bother. CONCLUSION: The patients who underwent RP had significantly worse urinary and better bowel function than those treated with XRT. Both treatment groups had decrements in sexual function throughout the post-treatment period; careful attention should be paid to this side-effect in preoperative counselling, especially in younger patients, regardless of the primary treatments.     

Prospective and longitudinal patient self-assessment of health-related quality of life following radical perineal prostatectomy

PURPOSE: We provide a comprehensive, longitudinal assessment of health related quality of life (HRQOL) following radical perineal prostatectomy (RPP). MATERIALS AND METHODS: We report the results of a prospective cohort study of 109 patients with at least 3 months of followup who underwent RPP between January 2001 and July 2003. A validated patient self-assessment questionnaire, the Expanded Prostate Cancer Index Composite, was administered preoperatively, and 1, 3, 6, 9, 12 and 18 months postoperatively. Mean domain specific HRQOL scores were calculated as well as the proportion of patients achieving an individual baseline by each interval. The Cox proportional hazards model was used to identify predictors of a successful return to baseline of disease specific HRQOL scores. RESULTS: HRQOL scores were lowest 1 month postoperatively and they increased with time. By 6 months a majority of patients had recovered baseline summary scores in urinary (65.1%), bowel (93.6%) and hormonal (91.7%) domains at a median of 5.8 (95% CI 3.6 to 6.2), 1.3 (95% CI 1.1 to 1.5) and 1.3 (95% CI 1.2 to 1.8) months, respectively. One in 4 patients recovered the sexual summary score by 18 months. Significant independent predictors for the recovery of domain summary scores were younger age in urinary (p = 0.001), individual surgeon in bowel (p = 0.022), and older age (p = 0.017) and absent medical comorbidities (p = 0.012) in hormonal domains. CONCLUSIONS: A majority of patients undergoing RRP experience an early recovery of individual urinary, bowel and hormonal HRQOL. Future studies should establish the benefit of bilateral nerve sparing RPP on the recovery of sexual domain HRQOL.     

保留Retzius间隙的机器人辅助腹腔镜下根治性前列腺切除术治疗早期前列腺癌(附手术视频)

目的:探讨保留Retzius间隙的机器人辅助腹腔镜下根治性前列腺切除术的初步应用。方法:2016年9~10月,入组早期前列腺癌10例,实施保留Retzius间隙的机器人辅助腹腔镜下根治性前列腺切除术。结果:10例手术均获成功,手术切缘均为阴性。完成手术时间170~250(196±25)min,术中出血量150~500(260±128)ml,术后住院日6~7 d,术后拔除导尿管时间14 d,仅1例患者存在尿失禁(每天1块尿垫),术后1个月完全恢复。结论:保留Retzius间隙的机器人辅助腹腔镜下根治性前列腺切除术安全、有效、可靠,有利于早期恢复控尿。     

Long-term health-related quality of life following robot-assisted radical transmediastinal esophagectomy

Surgical Endoscopy - The good short-term and oncological outcomes of robot-assisted radical esophagectomy have been demonstrated, although its impact on long-term health-related quality of life...     

Intermediate-term survival results in clinically understaged prostate cancer patients following radical prostatectomy

To determine the natural history of clinically understaged prostatic cancer patients who were followed without adjuvant therapy for at least 6 years after radical prostatectomy we reviewed the clinical courses of 21 patients (1 with clinical stage A and 20 with clinical stage B disease). All patients underwent radical retropubic prostatectomy and 9 had pathological stage C disease (6 with capsular penetration only and 3 with seminal vesicle invasion). A total of 12 patients had pathological stage D1 disease by virtue of positive nodes on permanent sections after frozen sections were read as negative. Among the patients with pathological stage C disease 67 per cent were free of recurrence 6 years after radical prostatectomy. Of the patients with seminal vesicle invasion 33 per cent had recurrence compared to 17 per cent of those with capsular penetration only. Among the 12 stage D1 cancer patients 75 per cent were free of recurrence at 6 years. In both groups patients who were followed beyond 7 years had a diminished survival free of tumor owing to late tumor recurrences. The results indicate that the intermediate survival rates free of tumor in patients with clinically understaged A or B prostatic cancer are remarkably good without adjuvant therapy. However, survival without recurrence appears to decrease after 7 years. All patients who failed treatment did so distantly; no patient failed with local recurrence alone. These results may be important in the evaluation of adjuvant therapy protocols currently under investigation for patients with clinically understaged prostate cancer.     

Prospective study of extended versus limited lymphadenectomy in patients undergoing radical prostatectomy with localized prostate cancer

Patients undergoing radical prostatectomy at our hospital from January 1995 until March 2008 were subjected to limited lymphadenectomy involving only the obturator nerve lymph node. In contrast to published reports, of 488 biopsies, we encountered only three cases of lymph node metastasis. Therefore, starting in April 2008, we conducted a prospective study of limited versus extended lymphadenectomy, the latter involving the obturator fossa and internal iliac lymph nodes. One hundred patients undergoing radical prostatectomy from April 2008 until January 2010 were divided into two groups depending on whether they underwent extended lymphadenectomy (n＝49) or limited lymphadenectomy (n＝51). There were no significant differences in the patient background, estimated blood loss, or operation time between the two groups. Lymphnode metastases were not detected in either group. A significantly greater number of lymph nodes was obtained from the extended lymphadenectomy group (average 14.1) than from the limited lymphadenectomy group (average 8.3 ; p＜0.01). Complications possibly attributable to lymphadenectomy included lymphocele in two patients in the limited group and one patient in the extended group. Extended lymphadenectomy was determined to be a safe procedure that provides the pathologist with a large sample size. None of the patients in either group harbored a detectable lymph node metastasis.     

DVC免缝扎技术在机器人辅助前列腺癌根治术中的应用

目的:探究机器人辅助前列腺癌根治术(RARP)中免缝扎背深静脉复合体(DVC)对术中失血、肿瘤控制效果、术后控尿功能恢复的影响。方法:回顾性分析本院2015年10月至2019年6月接受机器人辅助前列腺癌根治术的154例患者的病历资料,比较免缝扎DVC和常规缝扎DVC患者的相关指标,包括手术时间、术中出血量、术中输血率、切缘阳性率以及拔管后即刻、1、3个月尿失禁发生率。结果:免缝扎DVC组(A组)40例,常规缝扎DVC组(B组)114例。两组患者一般特征,包括年龄、体重质量指数(BMI)、前列腺癌危险分级及美国麻醉师协会(ASA)分级无统计学差异(P>0.05)。A组平均手术时间107.20 min显著短于B组113.25 min(P<0.05)。两组反映术中失血的指标Z值改变量分别为2.11与1.24(P>0.05),术中输血率分别为10.0%与15.8%,两组术中失血无统计学差异(P>0.05)。A组术后总体切缘阳性率15.0%和前列腺尖部切缘阳性率7.5%均与B组的15.8%和8.8%无显著差异(P>0.05;P>0.05),两种DVC处理对肿瘤的控制效果没有区别。A组拔管后即刻尿失禁发生率2.5%,和拔管后1个月尿失禁发生率0,均显著低于B组的17.5%和14.0%(P<0.05;P<0.05),但拔管后3个月,A组(0)与B组(7.9%)无显著差异(P>0.05)。结论:机器人辅助前列腺癌根治术中该DVC免缝扎技术在不会导致术中失血增加且切除肿瘤效果相当的情况下,缩短手术时间,促进术后尿控功能恢复。