New research was presented at AUA 2015, the annual meeting of the American Urological Association, from May 15 to 19 in New Orleans. The features below highlight some of the studies emerging from the conference that focused on surgery.
Comparing Adrenalectomy Procedures
The Particulars: Few studies have compared outcomes of open adrenalectomy (OA) with those of robot-assisted laparoscopic adrenalectomy (RALA).
Data Breakdown: Researchers conducted a matched pair analysis of single-side OAs and RALAs. The following was observed for RALA vs OA.
♦ Postoperative drop in hemoglobin: 1 point vs 2 points.
♦ Hospital length of stay: 7 days vs 11 days
♦ ICU length of stay: 1 day vs 2 days
Take Home Pearl: Outcomes of RALA appear to be superior to OA in multiple domains.
Predicting PVP Outcomes
The Particulars: Studies have yet to characterize predictors of perioperative complications and surgical re-intervention after photoselective vaporization of the prostate (PVP) for the treatment of symptomatic prostate enlargement (BPE).
Data Breakdown: For a study, nearly 800 patients who underwent PVP were analyzed over their first 2 years after the procedure. Intraoperative bleeding was observed in 9.1% of patients and was associated with use of 120- and 180-watt lasers. Investigators also found that 8.7% of patients were retained during hospitalization because they needed catheterization. Reoperation rates did not differ significantly by laser type (80-, 120- or 180-watt).
Take Home Pearls: Complication rates following PVP appear to be low. Reoperation within 2 year of PVP does not appear to be associated with laser type.
Smoking Worsens Major Urologic Surgery Outcomes
The Particulars: Data are lacking on the impact of current and prior smoking on outcomes among patients undergoing major urologic oncological procedures.
Data Breakdown: More than 9,000 patients undergoing prostate, bladder, or renal oncologic surgeries self-reported their smoking status at the time of surgery for a study. Current smokers had longer lengths of stay and significantly higher odds of pulmonary and renal complications following prostatectomy. Complications following cystectomy and nephrectomy did not differ by smoking status. However, current smokers were at higher risk for re-intervention after cystectomy and former smokers had increased odds for readmission.
Take Home Pearls: The effect of smoking on major urologic oncological surgery outcomes appears to be dependent on the type of procedure that patients undergo. However, current and former smoking worsened outcomes overall.
UAEs Unrelated to Cervical Cancer Treatment
The Particulars: Few studies that assess urinary adverse events (UAEs) among patients with cervical cancer have included long-term follow-up data. Comparing the long-term risks of UAEs between surgery and/or radiation for cervical cancer treatment can provide a more realistic assessment of the incidence of UAEs in this patient population.
Data Breakdown: Study investigators compared the incidence of UAEs among women aged 66 and older with non-metastatic cervical cancer who were treated with radiation, surgery, or both. UAEs occurred in 30.7% of women treated with external beam RT plus brachytherapy, 25.2% of those treated with radiation therapy plus surgery, and 15.8% of women treated with radical hysterectomy. The authors noted, however, that UAE risks increased with advanced disease regardless of the treatment they received.
Take Home Pearls: A significant number of women treated for cervical cancer appear to experience UAEs, particularly those with advanced disease. Although radiated women appear to be more likely to develop UAEs, these events seem to be more closely related to cancer stage than treatment.
Comparing Cystectomy Types in the Elderly
The Particulars: Previous research indicates that treatment for muscle-invasive bladder cancer (MIBC) is highly morbid largely because many patients are elderly at the time of cystectomy. A comparison of outcomes following robotic and open cystectomy could shed light on the optimal surgical approach for this patient population.
Data Breakdown: For a study, researchers compared outcomes at the time of either robotic or open cystectomy for MIBC among patients older than age 75. The average blood loss was less with robotic surgeries. Patients who underwent open surgery had a hospital length of stay of 8 days, compared with 7 days for robotic surgery patients. More than 60% of open surgery patients had a hospital day of more than 7 days, compared with a rate of just 7% that was seen among robotic surgery recipients. No significant differences were observed between the groups in the rates of surgical complications or 90-day readmissions.
Take Home Pearls: Robotic cystectomy appears to result in fewer blood transfusions and shorter hospital stays when compared with open cystectomy. However, radical cystectomy appears to be a morbid operation regardless of the surgical approach that is selected.