Short-, intermediate-, and long-term quality of life after laparoscopic radical prostatectomy--does the learning curve of LRP have a negative impact on patients' quality of life?

Department of Urology, University Hospital Basel, Basel, Switzerland.
European Urology (Impact Factor: 12.48). 05/2007; 51(4):1004-12; discussion 1012-4. DOI: 10.1016/j.eururo.2006.10.065
Source: PubMed

ABSTRACT To evaluate quality of life (QoL) after laparoscopic radical prostatectomy (LRP) and investigate whether the learning curve of laparoscopic novices has a negative influence on patients' QoL.
Evaluation of QoL with the EORTC QLQ C-30 and the PR25 preoperatively (t0) as well as postoperatively after 1-3 mo (t1), 4-6 mo (t2), 7-12 mo (t3), 13-24 mo (t4), and yearly thereafter (t5-t7). Surgeons were grouped according to their prior experience in laparoscopy into experienced and novices.
LRP was performed in 343 patients; 268 (78%) participated in the study. The mean patient age was 63.3+/-6.3 yr; mean PSA, 10.0+/-9.2 ng/ml; mean follow-up, 26 mo. Global health was impaired for t1 (p<0.001) and then returned to baseline. Emotional functioning improved (p<0.001) for t2-t7 versus baseline. Physical functioning remained impaired for t1-t2, and role and social functioning for t1-t6. Only sexual functioning did not return to baseline for t1-t7. Urinary symptoms were worse at t1 and then improved gradually (p<0.001). No significant difference in any QoL domain could be identified for experienced surgeons versus novices except for financial difficulties at t2-t3, which related to social differences. Thirty-one (9%) patients with adjuvant therapy had significantly worse global health, bowel symptoms, urinary symptoms, fatigue, and sexual functioning.
The learning curve of laparoscopic novices does not have a negative impact on patients' QoL. For intermediate- to long-term follow-up, patients reach their baseline or score even better in all domains except for sexual functioning but are significantly impaired if adjuvant treatment is performed.

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    ABSTRACT: To address concerns about the impact of training on patient outcomes during the 'learning curve' for laparoscopic radical prostatectomy (LRP), we compare the results of our patients undergoing LRP with and without trainees performing a substantial proportion of the cases. In all, 771 consecutive cases of LRP were performed or supervised by one surgeon during a 7.5-year period, of which 114 (15%) were training cases. A five-port transperitoneal technique was used in the first 111 patients and an extraperitoneal approach in the remaining 660. Patient, operative and oncological outcome variables were compared using an independent samples t-test if continuous or with Fisher's exact test for rates. There were no differences in preoperative patient or cancer characteristics with the exception of body mass index (BMI) which was lower in the training cases (medians 25 and 26 kg/m(2), P = 0.02) and patient age which was higher (medians 64 and 62 years, P < 0.001). Operative time, which was longer in training cases (medians 200 and 175 min, P < 0.001) was the only significantly different operative variable between the groups. There were no statistically significant differences in postoperative (duration of catheterization, hospitalization time, complication rates, biochemical recurrence and pad-free rates at 1 year) or pathological (gland weight, positive surgical margin rate) outcomes between the groups. As Fellows did not perform the posterior or apical dissection steps in nerve-sparing cases, no evaluation of potency outcomes is included. Training cases took a median of 25 min longer to complete than non-training cases. However, other perioperative measures, complications rates and cancer outcomes were similar. Adequately supervised training in LRP does indeed take additional time but is essential for the dissemination of surgical skills and preservation of acceptable outcomes.
    BJU International 12/2008; 103(9):1231-4; discussion 1234-5. · 3.13 Impact Factor
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    ABSTRACT: Background: To assess the process of obtaining proficiency in laparoscopic simple prostatectomy (LSP) by examining outcomes from our first 101 LSP cases. Methods: 101 consecutive patients with symptomatic benign prostatic hyperplasia underwent LSP between January 2003 and January 2008. Prostate volume, IPSS, uroflowmetry, post void residual, mean operative time, estimated blood loss, duration of catheter use, length of hospital stay, and complication rates were analyzed in this patient subset by dividing patients into one of two groups: Group 1, cases 1–50; Group 2, cases 51–101. Results: There was no difference between the groups in terms of age, prostate volume, uroflow, IPSS score or post void residual. There was a significant decrease in operative time between the two groups (107 􏰋 28.6 minutes vs 84 􏰋 33.1 minutes; p < 0.001). No significant difference was observed regarding mean blood loss (325 mL vs. 400 mL; p 1⁄4 0.275). Although minor complications were more numerous in the last 51 cases, major complications tended to decrease with time (p 1⁄4 0.014). The duration of bladder catheter tends to decrease after the 50th case (p < 0.001). Conclusion: Laparoscopic simple prostatectomy is safe with comparable outcomes to those published for open prostatectomy series. The operative time can be effectively reduced with practice and we estimate the learning curve for this procedure to be 50 cases.
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    ABSTRACT: To determine the systemic response to extraperitoneal laparoscopic (eLRP) and open retropubic radical prostatectomy (RRP). MATERIALS AND METHODS. In all, 430 patients who had eLRP (200) or open RRP (230) were re- cruited; patients in both groups had similar preoperative staging. In addition to peri-oper- ative variables (operative duration, complications, blood loss, transfusion rate, hospitaliza- tion, catheterization), oncological data (Gleason score, pathological stage, positive mar- gins) were also compared. The extent of the systemic response to surgery-induced tissue trauma was measured in all patients, by assessing the levels of acute-phase markers C-re- active protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and IL-10 before, during and after RP. RESULTS. The duration of surgery, transfusion rate, hospital stay and duration of catheteri- zation were comparable with those of previous studies. There was an increase in IL-6, CRP and SAA but no change in IL-10, and no differences between eLRP and RRP over the en- tire period assessed. CONCLUSION. The invasiveness of eLRP could not be substantiated objectively on the basis of the variables measured in this study. The surgical trauma and the associated invasive- ness of both methods were equivalent. (Urologia 2008; 75: 156-63)

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