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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.

Artikel i vetenskaplig tidskrift
Författare Prasanna Sooriakumaran
Giovannalberto Pini
Tommy Nyberg
Maryam Derogar
Johan Stranne
Anders Bjartell
Jonas Hugosson
Gunnar Steineck
Peter N Wiklund
Publicerad i European urology
Volym 73
Nummer/häfte 4
Sidor 618-627
ISSN 1873-7560
Publiceringsår 2018
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för onkologi
Institutionen för kliniska vetenskaper, Avdelningen för urologi
Sidor 618-627
Språk en
Länkar dx.doi.org/10.1016/j.eururo.2017.08...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Urologi och andrologi

Sammanfattning

Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable.To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping.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).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.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.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.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.

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