Article

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: 10.48). 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.

0 Bookmarks
 · 
47 Views
  • Source
    [Show abstract] [Hide abstract]
    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.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Detailed knowledge of quality of life (QoL) after permanent I-125 brachytherapy may aid in counselling patients with early-stage prostate cancer. Seventy-four consecutive patients with low-risk prostate cancer were asked to complete the EORTC QLQ-C30 questionnaire with the prostate-specific PR25 module before implant, four weeks and one year after implant (response rates 97%, 88% and 89%, respectively). Implant characteristics were correlated with QoL scores. Global QoL was stable from pre-treatment to one year after implant and similar to age-adjusted scores of healthy controls. Significant changes versus baseline in QLQ-C30 domains were worsened social function at four weeks, increased constipation at four weeks and at one year and improved emotional function at one year. PR25 urinary symptoms were significantly increased at four weeks and, despite some improvement, at one year; bowel symptoms were slightly increased. Both types of symptoms were most strongly related with pre-treatment symptom scores. Prostate-V150 was the only implant parameter significantly associated with both urinary and bowel symptoms at four weeks and one year. Limiting the high-dose subvolume in the prostate may be beneficial to reduce urinary and bowel symptoms but the major determinant of symptoms after I-125 implant is the baseline symptom level.
    Radiotherapy and Oncology 02/2009; 91(2):217-24. · 4.52 Impact Factor
  • [Show abstract] [Hide abstract]
    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. · 3.05 Impact Factor

Full-text

View
0 Downloads
Available from