Pentafecta: A New Concept for Reporting Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy

Imagem de Miniatura
Arquivos
art_PATEL_Pentafecta_A_New_Concept_for_Reporting_Outcomes_of_2011.PDF (124.48 KB)
Citações na Scopus
269
Tipo de produção
article
Data de publicação
2011
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCIENCE BV
Autores
PATEL, Vipul R.
SIVARAMAN, Ananthakrishnan
CHAUHAN, Sanket
PALMER, Kenneth J.
ORVIETO, Marcelo A.
CAMACHO, Ignacio
COUGHLIN, Geoff
ROCCO, Bernardo
Citação
EUROPEAN UROLOGY, v.59, n.5, p.702-707, 2011
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. Objective: A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. Design, setting, and participants: From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. Measurements: In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Results and limitations: Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p = 0.001) was confirmed as the only factor independently associated with the pentafecta. Conclusions: A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients' expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease.
Palavras-chave
Minimally invasisve, Robot assisted, Radical prostatectomy, Outcomes, Trifecta, Pentafecta, Counseling tool
URI
https://observatorio.fm.usp.br/handle/OPI/23598
Referências
  1. Novara G, 2010, EUR UROL, V57, P363, DOI 10.1016/j.eururo.2009.11.032
  2. Hong YM, 2010, UROL ONCOL-SEMIN ORI, V28, P268, DOI 10.1016/j.urolonc.2008.07.004
  3. Dindo D, 2004, ANN SURG, V240, P205, DOI 10.1097/01.sla.0000133083.54934.ae
  4. Patel VR, 2009, EUR UROL, V56, P472, DOI 10.1016/j.eururo.2009.06.007
  5. Coelho RF, 2011, EUR UROL, V59, P72, DOI 10.1016/j.eururo.2010.08.025
  6. Bill-Axelson A, 2008, J NATL CANCER I, V100, P1144, DOI 10.1093/jnci/djn255
  7. Wei JT, 2000, UROLOGY, V56, P899, DOI 10.1016/S0090-4295(00)00858-X
  8. Mendiola FP, 2008, J ENDOUROL, V22, P519, DOI 10.1089/end.2006.9845
  9. Eastham JA, 2008, J UROLOGY, V179, P2207, DOI 10.1016/j.juro.2008.01.106
  10. Novara G, 2011, BJU INT, V107, P100, DOI 10.1111/j.1464-410X.2010.09505.x
  11. Patel VR, 2005, J UROLOGY, V174, P269, DOI 10.1097/01.ju.0000162082.12962.40
  12. Martin RCG, 2002, ANN SURG, V235, P803, DOI 10.1097/00000658-200206000-00007
  13. Rosen RC, 1997, UROLOGY, V49, P822, DOI 10.1016/S0090-4295(97)00238-0
  14. Mulhall JP, 2009, J UROLOGY, V181, P462, DOI 10.1016/j.juro.2008.10.047
  15. Schroeck FR, 2008, EUR UROL, V54, P785, DOI 10.1016/j.eururo.2008.06.063
  16. Menon M, 2010, EUR UROL, V58, P838, DOI 10.1016/j.eururo.2010.09.010
  17. Shikanov SA, 2009, UROLOGY, V74, P619, DOI 10.1016/j.urology.2009.02.082
  18. Amling CL, 2000, J UROLOGY, V164, P101, DOI 10.1016/S0022-5347(05)67457-5
  19. CHARLSON ME, 1987, J CHRON DIS, V40, P373, DOI 10.1016/0021-9681(87)90171-8
  20. D'Amico AV, 2006, J UROLOGY, V176, pS11, DOI 10.1016/j.juro.2006.06.075
  21. Greene FL, 2002, AJCC CANC STAGING MA, V6th, P77
  22. Heidenreich A, 2009, ACTAS UROL ESP, V33, P113
  23. Rogers CG, 2006, J UROLOGY, V176, P2448, DOI 10.1016/j.juro.2006.07.153

Coleções
Artigos e Materiais de Revistas Científicas - HC/ICESP