Long‐term adverse effects after retropubic and robot‐assisted radical prostatectomy. Nationwide, population‐based study

Abstract

Background and ObjectivesSurgery for prostate cancer is associated with adverse effects. We studied long‐term risk of adverse effects after retropubic (RRP) and robot‐assisted radical prostatectomy (RARP).MethodsIn the National Prostate Cancer Register of Sweden, men who had undergone radical prostatectomy (RP) between 2004 and 2014 were identified. Diagnoses and procedures indicating adverse postoperative effects were retrieved from the National Patient Register. Relative risk (RR) of adverse effects after RARP versus RRP was calculated in multivariable analyses adjusting for year of surgery, hospital surgical volume, T stage, Gleason grade, PSA level at diagnosis, patient age, comorbidity, and educational level.ResultsA total of 11 212 men underwent RRP and 8500 RARP. Risk of anastomotic stricture was lower after RARP than RRP, RR for diagnoses 0.51 (95%CI = 0.42‐0.63) and RR for procedures 0.46 (95%CI = 0.38‐0.55). Risk of inguinal hernia was similar after RARP and RRP but risk of incisional hernia was higher after RARP, RR for diagnoses 1.48 (95%CI = 1.01‐2.16), and RR for procedures 1.52 (95%CI = 1.02‐2.26).ConclusionsThe postoperative risk profile for RARP and RRP was quite similar. However, risk of anastomotic stricture was lower and risk of incisional hernia higher after RARP.

National cohort study comparing severe medium‐term urinary complications after robot‐assisted vs laparoscopic vs retropubic open radical prostatectomy

“…In contrast, laparoscopic or open surgery usually uses between four and six interrupted sutures to approximate the bladder and urethra . As a result, there is likely to be a higher incidence of urinary leakage from the VUA, which can result in increased scarring/fibrosis around the anastomosis, with subsequent stricture formation . Furthermore, when performing RARP, a posterior reconstruction (Rocco) suture is often placed, which is another step often not performed during either LRP or ORP.…”

Risk of hernia formation after radical prostatectomy: a comparison between open and robot-assisted laparoscopic radical prostatectomy within the prospectively controlled LAPPRO trial

“…The online version of this article (https ://doi.org/10.1007/s1002 9-020-02178 -7) contains supplementary material, which is available to authorized users. * H. Nilsson hanna.nilsson@vgregion.se Extended author information available on the last page of the article an increased risk of developing an incisional hernia after RALP as compared to RRP, despite the longer incision of the latter [8,10,11,13]. Inguinal and incisional hernia may infrequently cause severe morbidity, and even mortality [14,15].…”

“…It has been suggested that it is the lower midline incision that induces the inguinal hernia formation and that all surgery performed by a lower midline incision could cause this complication [6]. Today a majority of prostate cancer operations are performed using robot-assisted laparoscopic technique (RALP) and hence several authors have addressed the question whether the risk of postoperative inguinal hernia is increased to the same extent after robot-assisted laparoscopic radical prostatectomy, reporting diverging results [5,[7][8][9][10].…”

Incidence And Risk Factors Of Inguinal Hernia Occurred After Radical Prostatectomy-comparisons of different approaches.

“…Some studies have found that minimally invasive methods (LRP or RALP) display lower cumulative PIH rates compared to RRP [8,9]. Nevertheless, a Nationwide, large population-based study demonstrated that no signi cant difference was found in risk of PIH between RRP and RALP with 11,212 patients [10]. Risk factors including age, body mass index (BMI) previous history of hernia or abdominal surgery, prostate volume pelvic lymph node dissection (PLND) incontinence outcome, operative time, surgeon experience and patent processus vaginalis have been studied to be presumably associated with PIH previously [11][12][13][14], but no consensus was reached due to various inclusion criteria and population heterogeneity.…”