Functional and oncologic outcomes between open and robotic radical prostatectomy at 24-month follow-up in the Swedish LAPPRO Trial Journal Article
| Authors: | Nyberg, M.; Hugosson, J.; Wiklund, P.; Sjoberg, D.; Wilderäng, U.; Carlsson, S. V.; Carlsson, S.; Stranne, J.; Steineck, G.; Haglind, E.; Bjartell, A.; on behalf of the LAPPRO group |
| Article Title: | Functional and oncologic outcomes between open and robotic radical prostatectomy at 24-month follow-up in the Swedish LAPPRO Trial |
| 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 limitation: 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. (C) 2018 European Association of Urology. Published by Elsevier B.V. |
| Keywords: | prostate cancer; radical prostatectomy; erectile dysfunction; urinary incontinence; biochemical recurrence; quality-of-life; metaanalysis; open radical prostatectomy; robot-assisted laparoscopic |
| Journal Title: | European Urology Oncology |
| Volume: | 1 |
| Issue: | 5 |
| ISSN: | 2588-9311 |
| Publisher: | Elsevier BV |
| Date Published: | 2018-10-01 |
| Start Page: | 353 |
| End Page: | 360 |
| Language: | English |
| ACCESSION: | WOS:000474600500001 |
| DOI: | 10.1016/j.euo.2018.04.012 |
| PROVIDER: | wos |
| PUBMED: | 31158073 |
| PMCID: | PMC7061692 |
| Notes: | Article -- Source: Wos |
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