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Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial

Nyberg, Martin LU ; Hugosson, Jonas ; Wiklund, Peter LU ; Sjoberg, Daniel ; Wilderäng, Ulrica ; Carlsson, Sigrid V ; Carlsson, Stefan ; Stranne, Johan ; Steineck, Gunnar and Haglind, Eva , et al. (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.

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European urology oncology
volume
1
issue
5
pages
353 - 360
publisher
Elsevier
external identifiers
  • scopus:85058964923
  • pmid:31158073
ISSN
2588-9311
DOI
10.1016/j.euo.2018.04.012
language
English
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yes
id
23587553-1aa6-4a3e-9b08-fa1ec3cca7ca
date added to LUP
2019-06-26 09:53:13
date last changed
2019-12-03 02:14:33
@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 &gt;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},
}