How May Longer Console Times Influence Outcomes after Robot-Assisted Radical Prostatectomy (RARP)?
Abstract
:1. Introduction
2. Methods
2.1. Surgical Procedure and Setting
2.2. Participants and Methods
2.3. Ethics Statement
3. Results
3.1. Baseline Parameters
3.2. Intraoperative Data
3.3. Complications and Readmissions
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ADT | Androgen deprivation therapy |
ASA | American association of anesthesiology comorbidity score |
AUR | Acute urinary retention |
BMI | Body mass index |
CD | Clavien–Dindo classification of postoperative complication |
HBG | Hemoglobin |
IIEF | International index of erectile function |
IPSS | International prostate symptom score |
ISUP | International Society of Urological Pathology |
NHT | neoadjuvant hormonal therapy |
NSTEMI | Non-ST-segment elevation myocardial infarction |
POD | Post-operative day |
PSA | Prostate-specific antigen |
PSM | Positive surgical margins |
TUR-P | Transurethral resection of the prostate |
RARP | Robot-assisted radical prostatectomy |
RPE | Retropubic radical prostatectomy |
SPC | Suprapubic catheter |
TUC | Transurethral catheter |
OR-time | Operating time |
LOS | Length of hospital stay |
UTI | Urinary tract infection |
VTE | Venous thromboembolism |
UUTO | Upper urinary tract obstruction |
VUA | Vesicourethral anastomosis |
VUAL | Vesicourethral anastomosis leakage |
References
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Total (500) | Short n = 157; 31.4% | Middle n = 255; 51% | Long n = 88; 17.6% | p-Value | |
---|---|---|---|---|---|
Age (year) | |||||
Mean ± SD | 66.8 ± 7.1 | 67 ± 6.7 | 67 ± 6.5 | 65.7 ± 9 | 0.260 |
Median | 68 | 68 | 68 | 67 | |
ASA score | |||||
1 | 96 (19, 2) | 36 (22, 9) | 40 (15, 7) | 20 (22, 7) | 0.777 |
2 | 314 (62, 8) | 90 (57, 3) | 175 (68, 6) | 49 (55, 7) | |
3 | 82 (16, 4) | 28 (17, 8) | 36 (14, 1) | 18 (20, 5) | |
Missing | 8 (1, 6) | 3 (1, 9) | 4 (1, 6) | 1 (1, 1) | |
Preoperative HGB (g/dL) | |||||
Mean ± SD | 14.7 ± 1.3 | 14.6 ± 1.1 | 14.7 ± 1.5 | 14.9 ± 1 | 0.613 |
median | 14.8 | 14.8 | 14.8 | 11 | |
IPSS | |||||
Mean ± SD | 11.4 ± 8.3 | 11 ± 8.3 | 11.3 ± 8.1 | 12.9 ± 9 | 0.383 |
median | 8.3 | 10 | 10 | 11 | |
IIEF | |||||
Mean ± SD | 15.2 ± 8.7 | 14.6 ± 8.5 | 15.6 ± 8.8 | 15.8 ± 7.8 | 0.261 |
median | 17 | 17 | 16 | 16 | |
Initial PSA (ng/mL) | |||||
Mean ± SD | 14.8 ± 24.5 | 16.2 ±27.8 | 13.8 ±20.6 | 16.5 ± 26.2 | 0.941 |
median | 8 | 7.5 | 8 | 9.3 | |
BMI | 28.4 ± 4.3 28 | 27.7 ± 4.5 27 | 28.8 ± 4.4 28 | 28.7 ± 4.4 28 | 0.261 |
Prostate volume (mL) | |||||
Mean ± SD | 49 ± 28 | 47 ± 23 | 49 ± 27 | 53 ± 38 | 0.236 |
median | 43 | 44 | 44 | 44 | |
Pre-treatment | |||||
Medical (NHT) | 55 (11) | 16 (10, 1) | 28 (11) | 11 (12, 5) | 0.881 |
Surgical (TUR-P) | 34 (6, 8) | 14 (8, 9) | 16 (6, 3) | 4 (4, 5) | 0.379 |
D’Amico risk classification | |||||
Low risk | 117 (23, 4) | 30 (19, 1) | 64 (25, 1) | 23 (26, 1) | 0.627 |
Intermediate risk | 229 (45, 8) | 78 (49, 7) | 112 (43, 9) | 39 (44, 3) | |
High risk | 154 (30, 8) | 49 (31, 2) | 79 (31) | 26 (29, 5) | |
Preoperative Gleason score | |||||
5 | 1 (0, 2) | 1 (0, 6) | 0 | 0.200 | |
6 | 140 (28) | 35 (22, 3) | 77 (30, 2) | 28 (12, 5) | |
3 + 4 | 176 (35, 2) | 63 (40, 1) | 80 (31, 4) | 33 (37, 5) | |
4 + 3 | 59 (11, 8) | 20 (12, 7) | 33 (12, 9) | 6 (6, 8) | |
8 | 82 (16, 4) | 27 (17, 2) | 44 (17, 3) | 11 (12, 5) | |
9 | 36 (7, 2) | 10 (6, 4) | 16 (6, 3) | 10 (11, 4) | |
10 | 5 (1, 0) | 1 (0, 6) | 4 (1, 6) | 0 | |
Unclassified | 1 (0, 2) | 0 | 1 (0, 4) | 0 | |
Nerve sparing | |||||
Yes | 374 (69, 4) | 99 (63, 1) | 184 (72, 2) | 64 (72, 7) | 0.548 |
Partial | 19 (3, 8) | 12 (7, 6) | 3 (1, 2) | 4 (4, 5) | |
No | 134 (26, 8) | 46 (29, 3) | 68 (26, 7) | 20 (22, 7) |
Total (500) | Short n = 157; 31.4% | Middle n = 255; 51% | Long n = 88; 17.6% | p-Value | |
---|---|---|---|---|---|
Console time mean ± SD | 151 ± 45 | 109 ± 13 | 150 ± 17 | 228 ± 38 | |
IQR | 120–180 | 100–120 | 135–160 | 200–240 | <0.001 |
median | 140 | 115 | 150 | 215 | |
Prostate weight (g) | |||||
Mean ± SD | 61 ± 25.6 | 60 ± 21.9 | 62.9 ± 25.7 | 61.2 ± 30 | 0.546 |
Median | 55 | 57 | 57 | 54 | |
Pathological stage | |||||
0 | 1 (0, 2) | 0 | 1 (0, 4) | 0 | 0.027 |
pT1 | 1 (0, 2) | 0 | 0 | 1 (1, 1) | |
pT2 | 295 (59) | 91 (58) | 147 (57, 7) | 57 (64, 7) | |
pT3 | 183 (36, 6) | 60 (38, 2) | 100 (39, 2) | 23 (26, 2) | |
pT4 | 20 (4, 0) | 6 (3, 8) | 7 (2, 7) | 7 (8) | |
Postoperative Gleason score | |||||
6 | 28 (5, 6) | 11 (7) | 12 (4, 7) | 5 (5, 7) | 0.217 |
3 + 4 | 282 (56, 4) | 86 (54, 8) | 152 (59, 6) | 44 (59) | |
4 + 3 | 89 (17, 8) | 23 (14, 6) | 46 (18) | 20 (22, 7) | |
8 | 26 (5, 2) | 11 (7) | 10 (3, 9) | 5 (5, 7) | |
9 | 29 (5, 8) | 10 (6, 4) | 11 (4, 3) | 8 (9, 1) | |
10 | 1 (0, 2) | 1 (0, 6) | 0 | 0 | |
Unclassified * | 45 (9, 0) | 15 (9, 6) | 24 (9, 4) | 6 (6, 8) | |
Positive surgical margins | 36 (7, 2) | 12 (7, 6) | 17 (6, 6) | 7 (8) | 0.892 |
Number of lymph nodes | |||||
Mean ± SD | 19.6 ± 7.4 | 19.2 ± 7.2 | 19.7 ± 7.3 | 20.9 ± 8.1 | 0.325 |
Median | 18 | 18 | 18.5 | 19 | |
Positive lymph nodes | 87 (17, 4) | 26 (16, 6) | 48 (18, 8) | 13 (14, 8) | 0.651 |
Hgb difference (g/dL) | |||||
Mean ± SD | 2.5 ± 4.8 | 2.5 ± 1.2 | 2.6 ± 1.38 | 3.18 ± 1.3 | 0.001 |
Median | 2.6 | 2.5 | 2.5 | 3 | |
Transfusion | 7 (1, 2) | 2 (1, 3) | 2 (0, 8) | 3 (3, 3) | 0.892 |
Hospitalization (days) | |||||
Mean ± SD | 5.6 ± 1.5 | 5.2 ± 1.1 | 5.5 ± 1.1 | 6.4 ± 2.7 | <0.001 |
Median | 5 | 5 | 5 | 6 | |
Catheter days | |||||
Mean ± SD | 6.9 ± 4.7 | 6.2 ± 3.7 | 6.8 ±4.6 | 9.1 ± 6.1 | <0.001 |
Median | 5 | 4 | 5 | 7 | |
Suprabubic catheter removed before discharge | 368 (73.6%) | 129 (82.2%) | 192 (75.3%) | 47 (53.4%) | <0.001 |
Complications in Detail | Total (n = 500) | Short n = 157; 31.4 | Middle n = 255; 51 | Long n = 88; 17, 6 | p-Value | ||
---|---|---|---|---|---|---|---|
Minor | 74 (14, 8) | 25 (15, 9) | 32 (12, 5) | 17 (19, 3) | 0.272 | ||
Minor | CDI 51 (10, 2) | VTE | 4 (0, 8) | 0 | 2 (0, 8) | 2 (2, 3) | 0.160 |
Elevated blood analysis parameters | 6 (1, 2) | 4 (2, 4) | 1 (0, 4) | 1 (1, 1) | |||
AUR | 28 (5, 6) | 11 (7) | 11(4, 3) | 6 (6, 8) | |||
Diverse | 13 (2, 6) | 6 (3, 6) | 6 (2, 4) | 1 (1, 1) | |||
CD II 23 (4, 6) | Secondary VUAL * | 11 (2, 2) | 2 (1, 3) | 7 (2, 7) | 2 (2, 3) | ||
UTI | 11 (2, 2) | 2 (1, 3) | 4 (1, 6) | 5 (5, 7) | |||
Hematoma requiring transfusion | 1 (0, 2) | 0 | 1 (0, 4) | 0 | |||
Major | 21 (4, 2) | 4 (2, 5) | 8 (3, 1) | 9 (10, 2) | 0.008 | ||
Major | CD III a 12 (2, 4) | Myocardial infarction | 1 (0, 2) | 0 | 1 (0, 4) | 0 | |
Hiatus hernia | 1 (0, 2) | 0 | 0 | 1 (1, 1) | |||
Symptomatic lymphocele | 10 (2.0) | 4 (2, 5) | 4 (1, 6) | 2 (2, 3) | |||
CD III b 8 (1, 6) | Revision | 5 (1.0) | 0 | 3 (1, 2) | 2 (2, 3) | ||
UUTO | 3 (0, 6) | 0 | 0 | 3 (3, 3) | |||
CD VI 1 (0, 2) | Rhabdomyolysis | 1 (0, 2) | 0 | 0 | 1 (1, 1) | ||
Readmissions | 28 (5, 6) | 6 (3, 8) | 15 (5, 9) | 7 (8) | 0.338 |
Readmission | Minor | Major Complications | Catheter Days | Hospital Stay | Lymphoceles | Positive Surgical Margins | Urinoma | Pulmonary Embolism | Transfusion | |
---|---|---|---|---|---|---|---|---|---|---|
console-Time | 0.417 | 0.527 | 0.569 | 0.012 | <0.001 | 0.373 | 0.664 | 0.234 | 0.190 | 0.073 |
D’Amico Classification | Prostate Volume | BMI | PSA | Gleason Score | Previous Medical Treatment (NHT) | Previous Prostate Surgery | |
---|---|---|---|---|---|---|---|
console-Time | 0.643 | 0.005 | 0.904 | 0.484 | 0.274 | 0.998 | 0.114 |
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Share and Cite
Farzat, M.; Elsherif, M.; Wagenlehner, F.M. How May Longer Console Times Influence Outcomes after Robot-Assisted Radical Prostatectomy (RARP)? J. Clin. Med. 2023, 12, 4022. https://doi.org/10.3390/jcm12124022
Farzat M, Elsherif M, Wagenlehner FM. How May Longer Console Times Influence Outcomes after Robot-Assisted Radical Prostatectomy (RARP)? Journal of Clinical Medicine. 2023; 12(12):4022. https://doi.org/10.3390/jcm12124022
Chicago/Turabian StyleFarzat, Mahmoud, Mohamed Elsherif, and Florian M. Wagenlehner. 2023. "How May Longer Console Times Influence Outcomes after Robot-Assisted Radical Prostatectomy (RARP)?" Journal of Clinical Medicine 12, no. 12: 4022. https://doi.org/10.3390/jcm12124022