Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy
Objectives: Neoadjuvant hormonal therapy (NHT) preceding robot-assisted radical prostatectomy (RARP) may be beneficial in high-risk cases to facilitate surgical resection. Yet, its improvement in local tumor control is not obvious. Its benefit regarding overall cancer survival is also not evident, a...
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MDPI AG
2023-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/9/3053 |
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| author | Mahmoud Farzat Peter Weib Iurii Sukhanov Josef Rosenbauer Christian Tanislav Florian M. Wagenlehner |
| author_facet | Mahmoud Farzat Peter Weib Iurii Sukhanov Josef Rosenbauer Christian Tanislav Florian M. Wagenlehner |
| author_sort | Mahmoud Farzat |
| collection | DOAJ |
| description | Objectives: Neoadjuvant hormonal therapy (NHT) preceding robot-assisted radical prostatectomy (RARP) may be beneficial in high-risk cases to facilitate surgical resection. Yet, its improvement in local tumor control is not obvious. Its benefit regarding overall cancer survival is also not evident, and it may worsen sexual and hormonal functions. This study explores the effect of NHT on the perioperative course after RARP. Methods: In this study, 500 patients from a tertiary referral center who underwent RARP by a specialized surgeon were retrospectively included. Patients were divided into two groups: the NHT (<i>n</i> = 55, 11%) group, which included patients who received NHT (median: 1 month prior to RARP), and the standard non-NHT (NNHT) group (<i>n</i> = 445, 89%). Demographic and perioperative data were analyzed. Postoperative results, complications, and readmission rates were compared between the groups. Results: NHT patients were heterogeneous from the rest regarding cancer parameters such as PSA (25 vs. 7.8 ng/mL) and tumor risk stratification, and they were more comorbid (<i>p</i> = 0.006 for the ASA score). They also received fewer nerve-sparing procedures (14.5% vs. 80.4%), while the operation time was similar. Positive surgical margins (PSM) (21.8% vs. 5.4%) and positive lymph nodes (PLN) (56.4% vs. 12.7%) were significantly higher in the NHT group compared to the non-NHT (NNHT) group. Hospital stay was equal, whereas catheter days were 3 days longer in the NHT group. NHT patients also suffered more minor vesicourethral-anastomosis-related complications. Major complications (<i>p</i> = 0.825) and readmissions (<i>p</i> = 0.070) did not differ between groups. Conclusion: Patients receiving NHT before RARP did not experience more major complications or readmissions within 90 days after surgery. Patients with unfavorable, high-risk tumors may benefit from NHT since it facilitates surgical resection. Randomized controlled trials are necessary to measure the advantages and disadvantages of NHT. |
| first_indexed | 2024-03-11T04:15:08Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T04:15:08Z |
| publishDate | 2023-04-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-5155fcc27b764b86a8f1fef33faf73f52023-11-17T23:10:06ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01129305310.3390/jcm12093053Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical ProstatectomyMahmoud Farzat0Peter Weib1Iurii Sukhanov2Josef Rosenbauer3Christian Tanislav4Florian M. Wagenlehner5Department of Urology and Robotic Urology, Diakonie Klinikum Siegen, Academic Teaching Hospital of the University of Bonn, 57074 Siegen, GermanyDepartment of Urology and Robotic Urology, Diakonie Klinikum Siegen, Academic Teaching Hospital of the University of Bonn, 57074 Siegen, GermanyDepartment of Urology and Robotic Urology, Diakonie Klinikum Siegen, Academic Teaching Hospital of the University of Bonn, 57074 Siegen, GermanyDepartment of Geriatric and Neurology, Diakonie Klinkum Siegen, Academic Teaching Hospital of the University of Bonn, 57074 Siegen, GermanyDepartment of Geriatric and Neurology, Diakonie Klinkum Siegen, Academic Teaching Hospital of the University of Bonn, 57074 Siegen, GermanyDepartment of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35392 Giessen, GermanyObjectives: Neoadjuvant hormonal therapy (NHT) preceding robot-assisted radical prostatectomy (RARP) may be beneficial in high-risk cases to facilitate surgical resection. Yet, its improvement in local tumor control is not obvious. Its benefit regarding overall cancer survival is also not evident, and it may worsen sexual and hormonal functions. This study explores the effect of NHT on the perioperative course after RARP. Methods: In this study, 500 patients from a tertiary referral center who underwent RARP by a specialized surgeon were retrospectively included. Patients were divided into two groups: the NHT (<i>n</i> = 55, 11%) group, which included patients who received NHT (median: 1 month prior to RARP), and the standard non-NHT (NNHT) group (<i>n</i> = 445, 89%). Demographic and perioperative data were analyzed. Postoperative results, complications, and readmission rates were compared between the groups. Results: NHT patients were heterogeneous from the rest regarding cancer parameters such as PSA (25 vs. 7.8 ng/mL) and tumor risk stratification, and they were more comorbid (<i>p</i> = 0.006 for the ASA score). They also received fewer nerve-sparing procedures (14.5% vs. 80.4%), while the operation time was similar. Positive surgical margins (PSM) (21.8% vs. 5.4%) and positive lymph nodes (PLN) (56.4% vs. 12.7%) were significantly higher in the NHT group compared to the non-NHT (NNHT) group. Hospital stay was equal, whereas catheter days were 3 days longer in the NHT group. NHT patients also suffered more minor vesicourethral-anastomosis-related complications. Major complications (<i>p</i> = 0.825) and readmissions (<i>p</i> = 0.070) did not differ between groups. Conclusion: Patients receiving NHT before RARP did not experience more major complications or readmissions within 90 days after surgery. Patients with unfavorable, high-risk tumors may benefit from NHT since it facilitates surgical resection. Randomized controlled trials are necessary to measure the advantages and disadvantages of NHT.https://www.mdpi.com/2077-0383/12/9/3053prostate cancerRARPneoadjuvant hormonal therapy |
| spellingShingle | Mahmoud Farzat Peter Weib Iurii Sukhanov Josef Rosenbauer Christian Tanislav Florian M. Wagenlehner Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy Journal of Clinical Medicine prostate cancer RARP neoadjuvant hormonal therapy |
| title | Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy |
| title_full | Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy |
| title_fullStr | Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy |
| title_full_unstemmed | Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy |
| title_short | Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy |
| title_sort | effect of neoadjuvant hormonal therapy on the postoperative course for patients undergoing robot assisted radical prostatectomy |
| topic | prostate cancer RARP neoadjuvant hormonal therapy |
| url | https://www.mdpi.com/2077-0383/12/9/3053 |
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