Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial
(2018) In European Urology Oncology 1(5). p.353-360- 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... (More)
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 LIMITATIONS: 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.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2018-10
- type
- Contribution to journal
- publication status
- published
- subject
- in
- European Urology Oncology
- volume
- 1
- issue
- 5
- pages
- 353 - 360
- publisher
- Elsevier
- external identifiers
-
- pmid:31158073
- scopus:85058964923
- ISSN
- 2588-9311
- DOI
- 10.1016/j.euo.2018.04.012
- language
- English
- LU publication?
- yes
- id
- 23587553-1aa6-4a3e-9b08-fa1ec3cca7ca
- date added to LUP
- 2019-06-26 09:53:13
- date last changed
- 2024-04-16 13:06:07
@article{23587553-1aa6-4a3e-9b08-fa1ec3cca7ca, abstract = {{<p>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.</p><p>OBJECTIVE: To present patient-reported functional outcomes and recurrent and residual disease at 24-mo follow-up from the prospective multicenter LAPPRO trial.</p><p>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.</p><p>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.</p><p>RESULTS AND LIMITATIONS: 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.</p><p>CONCLUSIONS: Extended follow-up corroborated our previous report at 12 mo of a persistent RALP benefit regarding potency.</p><p>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.</p>}}, author = {{Nyberg, Martin and Hugosson, Jonas and Wiklund, Peter and Sjoberg, Daniel and Wilderäng, Ulrica and Carlsson, Sigrid V and Carlsson, Stefan and Stranne, Johan and Steineck, Gunnar and Haglind, Eva and Bjartell, Anders}}, issn = {{2588-9311}}, language = {{eng}}, number = {{5}}, pages = {{353--360}}, publisher = {{Elsevier}}, series = {{European Urology Oncology}}, title = {{Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial}}, url = {{http://dx.doi.org/10.1016/j.euo.2018.04.012}}, doi = {{10.1016/j.euo.2018.04.012}}, volume = {{1}}, year = {{2018}}, }