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Prostate Cancer Prostatectomy
the US, the systematic application of specific clinical pathways length of hospitalisation sensitivity analysis identified that equivalence in
shortened hospitalisation after radical prostatectomy to less than three cost could be achieved only if LRP was performed on an outpatient basis
days.
10,24
In Europe, hospital stay is longer because patient dismissal is (less than one day length of stay).
8,27
Another way to reduce expenditure
based on complete patient recovery rather than hospitalisation costs.
15
is to decrease equipment costs,
8
especially disposable scissors and
Comparative studies between LRP and RRP showed similar
7,14,19
or trocars.
27
Complications certainly influence the total cost of any surgical
shorter hospitalisation in patients undergoing laparoscopic procedure. If the lower rates of complications with LRP prove to be
treatment.
10,11,15,16,25
The mean length of hospital stay was 2.2 days reproducible,
14,21,22
this may greatly narrow the cost differential between
(range 1.7 to three days) and 8.7 days (range seven to 12 days) for LRP LRP and RRP.
27
in US and European studies, respectively. For RRP, the mean length of
hospitalisation was 2.8 days (range 2.4 to three days) in the US and Taking into account the costs resulting from missed work during
12.4 days (range 10–16 days) in Europe. convalescence, and that mean time to full recovery is 32 and 53 days
after LRP and RRP, respectively,
14,19,22
a 21-day difference in return to
Duration of Catheterisation work has a value to society that eliminates and even reverses the cost
Bladder catheterisation is shorter with LRP than with RRP.
9,12,14,16,19,21,22
advantage of RRP.
The mean catheterisation time was 7.6 days (range 5.8–14 days) after
LRP and 14.1 days (range 7.8–22 days) after RRP. The significantly Functional Outcomes
higher percentage of successful early catheter removal in the
laparoscopic group suggests a superiority of the quality of laparoscopic Urinary Continence
vesicourethral anastomosis.
13,18
The advantage of the laparoscopic Patient age, baseline incontinence, prior transurethral resection
anastomosis lies in the improved visualisation under magnification of of the prostate, surgical technique and surgeon experience are important
the operating field.
13,18,26
risk factors for urinary continence after radical prostatectomy.
26
Numerous refinements of the radical prostatectomy technique have
Peri-operative Complications significantly reduced the post-operative incidence of incontinence.
Unclear and non-standardised reporting makes the interpretation of These refinements include pupoprostatic ligament sparing, meticulous
complication rates difficult.
6
Several studies comparing LRP and RRP bleeding control from the dorsal venous complex, delicate apical
showed similar medical and surgical complication rates,
7,9,10,16,20
with an dissection, preservation of the bladder neck, avoidance of coagulation in
average of 19% (range 5.1–37%) and 15% (range 8.3–20%), the proximity of the neurovascular bundles and a watertight
respectively. Other studies showed that early and minor complications urethrovesical anastomosis.
9,12,26,28
occurred more frequently with RRP than with LRP,
14,21,22
but the spectrum
of the complications differed.
14
In the laparoscopic group there were Following radical prostatectomy, urinary continence rates can vary
more rectal injuries, urinary leakage and prolonged ileus compared with significantly in relation to the different continence criteria applied and to
the open group.
7,14
On the other hand, incidences of anastomotic the modality of data collection.
10
Defined as the use of no pads, diurnal
strictures, wound-related complications, lymphoceles and pulmonary and nocturnal urinary continence rates are reported to be similar
embolism were higher after open surgery than laparoscopy.
14,21,22
between LRP and RRP after 12 and 18 months of surgery.
7,9,14,15,21,26,29
After LRP, the mean continence rate was 81.7% (range 60–91.7%) at 12
Short-term Convalescence months, and 94.3% (range 92.8–95.8%) at 18 months. After RRP, the
Compared with patients undergoing RRP, patients undergoing LRP have mean continence rate was 83.5% (range 66.7–92.9%) and 92.6%
a faster return to partial recovery – defined as independence with no (range 92–93.2%) at 12 and 18 months, respectively.
need of assistance from others with routine daily tasks – and a faster
return to full recovery – defined as complete physical strength with Erectile Function
recovery to the pre-operative state.
14,19,22
Partial and full recovery were Patient age, baseline quality of erections, stability of relationships,
achieved after a mean of 13 days (range 12–14 days) and 32 days (range cardiovascular co-morbidities, the degree of neurovascular bundle
27–39 days), respectively, for patients undergoing LRP, and 23 days preservation achieved during surgery and the experience of the surgeon
(range 21–25 days) and 53 days (range 47–61 days), respectively, for all contribute to the final potency status after radical prostatectomy.
9,18,24
those undergoing RRP.
19,22
An objective evaluation of erectile function is difficult because of
heterogeneous definitions and methods of evaluation of sexual
Costs potency.
28
Potency rates – defined as erections resulting in successful
RRP is significantly less expensive than LRP,
8,25
with most of the difference sexual intercourse – are similar at 12 and 18 months after surgery.
7,9,21
resulting from the higher surgical supply costs and operating room costs After preservation of both neurovascular bundles, the potency rates after
in the LRP group.
25
With the significantly shorter length of hospitalisation 12 months were 67.6% (range 53–79.5%) after LRP and 57.4% (range
after LRP the room and board costs were lower, but this difference was 44–72.4%) after RRP.
not enough for LRP to make up the deficit from the surgical supply and
operating room costs.
25
Quality of Life
Studies evaluating quality of life (QOL) using validated questionnaires
Refinements to the laparoscopic technique and improvements in available found no differences in functional status, urological symptoms, physical
laparoscopic devices – potentially decreasing the operating time – would comfort, psychological distress and social activity before and after surgery
allow a cost equivalency with RRP.
8,25
A decrease in operating time by for open and laparoscopic prostatectomy.
26,30
Another study showed
159–174 minutes would make LRP costs equivalent to those of RRP.
8,27
A significantly higher QOL scores in the LRP group compared with RRP up
36 EUROPEAN UROLOGICAL REVIEW