Changes in quality of life in first year after radical prostatectomy by retropubic, laparoscopic, and perineal approach: Multi-institutional longitudinal study in Japan

doi:10.1016/j.urology.2005.09.004

Urology

Volume 67, Issue 2, February 2006, Pages 321-327

https://doi.org/10.1016/j.urology.2005.09.004 Get rights and content

Abstract

Objectives

To investigate the health-related quality of life of patients who underwent radical prostatectomy performed using retropubic, laparoscopic, and perineal approaches.

Methods

A total of 218 men who underwent retropubic prostatectomy, 65 who underwent laparoscopic prostatectomy, and 66 who underwent perineal prostatectomy were enrolled in our survey. A baseline interview was conducted before treatment. Follow-up interviews were conducted in person at scheduled study visits 1, 3, 6, and 12 months after surgery. We measured two validated questionnaires that assessed the general and disease-specific health-related quality of life.

Results

The retropubic group reported substantial deterioration in physical limitations, emotional limitations, social function, and bodily pain at 1 month. The perineal group reported less bodily pain just after surgery than the retropubic and laparoscopic groups. After 6 months, however, no significant differences were found among the three groups. Postoperative urinary function remained substantially lower than the baseline level in every treatment group. Each approach with a nerve-sparing procedure showed a similar recovery profile of urinary function postoperatively. The perineal group reported no significant difference in bowel function compared with the other two groups. All of the groups continued to have decrements in sexual function.

Conclusions

The results of this study have demonstrated that retropubic, laparoscopic, and perineal prostatectomy have differences in the recovery of general and disease-specific quality of life in the early postoperative period. When performed by an experienced surgeon, the retropubic, laparoscopic, and perineal approaches appear to be equivalent in terms of health-related quality of life.

Section snippets

Patient Population and Data Collection

Between April 2003 and March 2004, a total of 357 patients with localized prostate cancer were treated with radical prostatectomy alone. The indications for a nerve-sparing procedure depended on the preoperative (number and Gleason score of the positive biopsy cores, prostate-specific antigen level, or patient preference) and intraoperative factors, prioritizing cancer control. Retropubic prostatectomy was performed by five staff urologists or under their supervision. Each surgeon had

Results

Only patients with preoperative HRQOL data and data from at least two later times were included in the analysis, resulting in a final study cohort of 349 patients (218, 65, and 66 for the retropubic, laparoscopic, and perineal groups, respectively). The demographic and clinical characteristics of the patient population are summarized in Table I. Patients from the laparoscopic group were significantly younger than those from the perineal group (P = 0.006). The average prebiopsy prostate-specific

Comment

Our study results have demonstrated several important findings. It appears to be difficult for patients treated with any type of surgery to return completely to the baseline level of urinary continence. In our experience, the laparoscopic group seemed to show delayed recovery of urinary function and bother compared with the retropubic or perineal groups. Studies of urinary function after radical prostatectomy have been confounded by conflicting results. In a prospective comparison of 70

Acknowledgment

To Drs. Shiro Baba, Hidetoshi Kuruma, Yukio Usui, Tsuguru Usui, Tatsuro Yoneda, Sadafumi Kawamura, Masaaki Kuwahara, Masataka Aizawa, Koji Yoshimura, and Kentaro Ichioka and associated nurses for their assistance.

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Cited by (28)

Comparison of outpatient narcotic prescribing patterns after minimally invasive versus retropubic and perineal radical prostatectomy
2011, Journal of Urology
Studies comparing pain after minimally invasive vs retropubic and perineal radical prostatectomy are conflicting. We characterized population based outpatient narcotic prescribing patterns after minimally invasive, retropubic and perineal radical prostatectomy.
We evaluated outpatient prescription data after minimally invasive, retropubic and perineal radical prostatectomy from 2003 to 2006 using MarketScan®. Baseline and postoperative narcotic prescriptions were identified using the National Drug Code. Total prescribed narcotic strength in morphine sulfate equivalents, the number of prescriptions filled and costs were compared. We performed multivariate analysis adjusted for surgical approach, age, comorbidity, baseline narcotic use, health plan and geographic region.
We identified 2,206 minimally invasive, 8,037 retropubic and 463 perineal radical prostatectomies with no differences in baseline narcotic prescription use. Perineal and retropubic operations were associated with greater total morphine sulfate equivalent use than the minimally invasive operation. Perineal prostatectomy was associated with more narcotic refills than minimally invasive and retropubic prostatectomy (42.3% vs 20.2% and 28.9%, respectively, p <0.001). Median narcotic costs were lower for minimally invasive than for perineal and retropubic prostatectomy. On adjusted analysis perineal radical prostatectomy, younger age, baseline narcotic use and preferred provider organization health plan were associated with greater morphine sulfate equivalents and narcotic refills while minimally invasive surgery was associated with fewer refills and lower costs but not with total morphine sulfate equivalents. There was significant geographic variation in narcotic use and costs.
Postoperatively minimally invasive radical prostatectomy required fewer narcotic refills and had lower narcotic costs while perineal radical prostatectomy required the greatest amount of narcotics. However, minimally invasive vs retropubic radical prostatectomy morphine sulfate equivalent requirements did not differ on adjusted analysis. While our findings support the purported advantage of minimally invasive radical prostatectomy of less postoperative pain, confirmatory prospective studies with objective outcomes are needed.
Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Systematic Review and Cumulative Analysis of Comparative Studies
2009, European Urology
Citation Excerpt :
Three prospective, nonrandomised studies compared the impact of RRP or LRP on the HRQoL of the patients with prostate cancer. All the studies came from Japan and proposed 6-mo assessments [25] and 12-mo assessments [27,29]. Hara et al evaluated 57 patients treated by RRP and 54 who had undergone LRP using the European Organisation for Research and Treatment of Cancer (EORTC) prostate cancer questionnaire, IIEF-5, and the International Continence Society short form (ICS-SF).
Despite the wide diffusion of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP), only few studies comparing the results of these techniques with the retropubic radical prostatectomy (RRP) are currently available.
To evaluate the perioperative, functional, and oncologic results in the comparative studies evaluating RRP, LRP, and RALP.
A systematic review of the literature was performed in January 2008, searching Medline, Embase, and Web of Science databases. A “free-text” protocol using the term radical prostatectomy was applied. Some 4000 records were retrieved from the Medline database; 2265 records were retrieved from the Embase database;, and 4219 records were retrieved from the Web of Science database. Three of the authors reviewed the records to identify comparative studies. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK).
Thirty-seven comparative studies were identified in the literature search, including a single, randomised, controlled trial.
With regard to the perioperative outcome, LRP and RALP were more time consuming than RRP, especially in the initial steps of the learning curve, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates all favoured LRP. With regard to the functional results, LRP and RRP showed similar continence and potency rates. Similarly, no significant differences were identified between LRP and RALP, while a single, nonrandomised, prospective study suggested advantages in terms of both continence and potency recovery after RALP, compared with RRP. With regard to the oncologic outcome, LRP and RALP were associated with positive surgical margin rates similar to those of RRP.
The quality of the available comparative studies was not excellent. LRP and RALP are followed by significantly lower blood loss and transfusion rates, but the available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. Further high-quality, prospective, multicentre, comparative studies are needed.
Penile Rehabilitation Following Radical Prostatectomy: Role of Early Intervention and Chronic Therapy
2007, Urologic Clinics of North America
The increase in the number of prostate cancer survivors and their relatively young age has prompted many urologists to concentrate on early penile rehabilitation to improve potency rates following radical prostatectomy. Positive results from various procedures range from 14% to 81% following bilateral nerve-sparing laparoscopic radical prostatectomy, to 43% to 97% following robotic-assisted laparoscopic prostatectomy. An early program with an erectaid improves erectile physiology and performance and logistically, the combination of a 5-phosphodiesterase inhibitor and a vacuum constriction device may prove to be the most user-friendly, cost-effective, and patient-compliant. Other issues that affect patient compliance, such as loss of interest and fear of undertaking sexual activity, will only be revealed through long-term patient follow-up and care.
Prospective Evaluation of Short-Term Impact and Recovery of Health Related Quality of Life in Men Undergoing Robotic Assisted Laparoscopic Radical Prostatectomy Versus Open Radical Prostatectomy
2007, Journal of Urology
In the last few years there have been increasing claims that robotic assisted laparoscopic radical prostatectomy decreases short-term morbidity in patients undergoing surgical treatment for prostate cancer. However, there is surprisingly little objective evidence to support this point, which is often used to market the procedure to patients. To address this issue we prospectively evaluated patients undergoing open and robotic assisted laparoscopic radical prostatectomy at baseline and weekly through the postoperative period using a validated questionnaire.
A total of 162 men undergoing radical prostatectomy, including open radical prostatectomy in 120 and robotic assisted laparoscopic radical prostatectomy in 42, for clinically localized prostate cancer completed the SF-12™, version 2 Physical and Mental Health Survey Acute Form preoperatively and each week postoperatively for 6 weeks. Physical and Mental Component Scores were calculated from the questionnaires at each time point. Comparisons between the 2 surgical approaches were made at each time point.
No significant differences were seen between the open and robotic assisted laparoscopic radical prostatectomy groups with regard to patient age, clinical stage or preoperative prostate specific antigen. Mean surgical blood loss was significantly higher in the open group compared to that in the robotic assisted laparoscopic group. Physical Component Scores in the robotic assisted laparoscopic group were significantly higher than those in the open cohort beginning postoperative week 1 and extending through week 6. On statistical extrapolation Physical Component Scores returned to baseline between weeks 5 and 6 postoperatively in the robotic assisted laparoscopic group and between weeks 6 and 7 in the open group. Mental Component Score scores were not statistically different between the groups except preoperatively.
This study helps prospectively define short-term health related quality of life in patients undergoing robotic assisted laparoscopic vs open radical prostatectomy. Higher physical scores were seen in the robotic assisted laparoscopic group than the open group beginning postoperative week 1 and continuing weekly throughout the 6-week study period. Physical Component Score scores returned to baseline sooner in the robotic assisted laparoscopic group than in the open group.
Laparoscopic Radical Prostatectomy in Men Older than 70 Years of Age with Localized Prostate Cancer: Comparison of Morbidity, Reconvalescence, and Short-Term Clinical Outcomes between Younger and Older Men
2007, European Urology
Citation Excerpt :
Because urinary incontinence is a patient’s main concern, the shorter duration of bladder catheterization and the earlier recovery of continence in young men after eL-RPE seemed to affect positively the recovery of their general health-related QoL. Importantly, others have shown that the decreased period of indwelling urethral catheter and hospital stay in L-RPE men was a source of a more favorable attitude toward surgery [22]. Consistent with our observations, Hara [25] and Soderdahl et al [23], who performed a cross-sectional retrospective and a prospective longitudinal study, respectively, found no statistically significant differences regarding the recovery of urinary-related QoL between patients who underwent L-RPE or OPEN-RPE.
To analyze the safety and efficacy of extraperitoneal laparoscopic radical prostatectomy (eL-RPE) in elderly versus younger men with localized prostate cancer.
Patients undergoing eL-RPE were retrospectively subdivided into group eL-RPE1 (72 men aged 71 yr and older) and group eL-RPE2 (132 men aged 59 yr and younger). Group eL-RPE1 was compared with a group of 70 contemporary, comparable patients aged 71 yr and older undergoing open retropubic radical prostatectomy (group OPEN-RPE).
Compared with group eL-RPE2, patients of group eL-RPE1 had a higher pathologic stage (45% vs. 32% stage pT3 or greater, p < 0.001) and higher Gleason score (median 7 vs. 6, p < 0.001). Prostate-specific antigen recurrence was significantly worse compared with age-matched controls for younger patients with high-stage or high-grade lesions (p < 0.001). Importantly operative time, analgesic requirements, hospital stay, convalescence, and complication rates were comparable. Urinary continence rate was significantly better in group eL-RPE2 at 6 mo (67% vs. 91%, respectively, p < 0.001). Group eL-RPE1 and group OPEN-RPE patients had statistically similar pathologic stage and Gleason score (each p > 0.05), similar operative time (p = 0.12), but less blood loss (p < 0.001), shorter hospital stay (p < 0.001), and more rapid convalescence (p < 0.001) occurred in eL-RPE1.
eL-RPE is feasible and efficacious even in elderly patients with unfavorable, large-volume disease. eL-RPE offers the advantages of decreased blood loss, shorter hospital stay, and more rapid recovery over OPEN-RPE. However, the elderly patient must be informed preoperatively about the observed higher incontinence rate.
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?
2007, European Urology
Citation Excerpt :
The only difference was that patients treated with LRP displayed a significantly more favourable attitude towards the operation compared with patients treated with open surgery. Namiki et al [8] found after comparing LRP, RRP and perineal prostatectomy that urinary function was worse 1 mo after surgery and then gradually improved compared with baseline levels. Leakage was worse for LRP compared with other treatment modalities in the first month after operation and then lost its significance for longer follow-up.
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.

View all citing articles on Scopus

: This study was supported in part by a grant from Suzuki Urological Foundation, and the Ministry of Health and Welfare of Japan.

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Adult urologyChanges in quality of life in first year after radical prostatectomy by retropubic, laparoscopic, and perineal approach: Multi-institutional longitudinal study in Japan

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Patient Population and Data Collection

Results

Comment

Acknowledgment

J Urol

J Urol

Eur Urol

Urology

Urology

J Urol

J Urol

J Urol

J Urol

J Urol

Urology

Urology

Adult urology
Changes in quality of life in first year after radical prostatectomy by retropubic, laparoscopic, and perineal approach: Multi-institutional longitudinal study in Japan