Influence of experience of endoscopic radical prostatectomy for its results in patients with localized prostate cancer in clinic of SI «Institute of urology of NAMS Ukraine» during the five-year term
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Abstract
The objective: The purpose of our study is to research and compare the results of radical surgical treatment of patients with localized prostate cancer (PC) undergoing endoscopic radical prostatectomy (ERP) at the conditional stages of «implementation» and the «becoming» of these techniques in the clinic.
Materials and methods. There were implemented an assessment of the results of treatment of localized PC of 261 patients who had undergone ERP in the clinic of the SI «Institute of Urology of NAMS Ukraine» during 2012–2016 years inclusively. The patients were divided into two groups according to the depersonalized calendar principle. Group 1 included 99 (37,93%) patients who had been performed ERP in the period from 2012 till 2014 years (the conditional stage of ERP «implementation» in the clinic). Group 2 included 162 (62,07%) patients who had been undergone ERP in the period from 2015 till 2016 years (the conditional stage of ERP «becoming» in the clinic). The clinical, laboratory, computational and pathomorphological data for each patient were analyzed. The data were processed using descriptive, parametric and nonparametric statistics (t-test, Mann-Whitey test, χ2 Pearson) and others.
Results. Patients in groups 1 and 2 were not significantly different in age (p=0,342), body weight (p=0,839), total PSA before surgical treatment (p=0,464), prostate volume (p=0,507), the presence of middle lobe of prostate more than 1 sm (p=0,882) or postoperative hospital stay (p=0,613). A statistically significant increasing of the number of patients, who had been underwent neoadjuvant therapy before performing ERP, were revealed in group1 in relation to group 2 (p=0,012). Frequency of haemotransfusions was 17,17% vs 6,79%, the volume of intraoperative blood loss was 500 [235; 800] vs 250 [150; 400] ml, median time for catheterization of the bladder was 12 [9; 15] vs 11 [8; 14] days and ΔHb was -24 [-33; -14] vs ‑19 [-28, 25; -11] g/l in group 1 vs 2, accordingly. There were 69 complications in group 1 of 38 (38,38%) patients and 75 complications in group 2 of 56 (34,57%) patients. Genitourinary complications were prevalented in both cohorts of patients, dissemination of which in group 1 was 34,34%, and in group 2 – 29,01%. Leakage of VUA had the highest incidence rate of the total complexity of the complications: 18,18% for group 1 and 10,49% for group 2. The «small» complications (Clavien I-II) were dominated in both groups: 58,59% and 35,8%, while the «major» complications (Clavien III-IV) were fixed at 11,11% and 10,49% in groups 1 and 2, respectively. The number of patients with complications in the studied groups was comparable (p=0,534), however, their distribution varied.
Conclusions. The acquisition of experience in the performing of ERP by the staff of the institute led to a statistically significant reduction of the time of catheterization of the bladder (p=0,018), the volume of intraoperative blood loss (p<0,001), the frequency of conducting haemotransfusion (p=0,009), decreasing of the general prevalence of postoperative complications (p<0,001), as well as the prevalence of «small» (Clavien I–II) postoperative complications (p<0,001) without statistically significant difference on the similar indicator for «major» (Clavien III–V) postoperative complications (p=0,876) in the group of the conditional stage of ERP formation relative to the group of the conditional stage of ERP «implementation». The complication which was most often diagnosed in patients in both groups, had been the leakage of VUA. That required to improve of the technique of the formation of VUA during ERP.##plugins.themes.bootstrap3.article.details##
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