MP15: Prostate Cancer: Localized: Surgical Therapy I
MP15-15: Is postoperative pelvic pain after robot-assisted radical prostatectomy associated with suture material used for sewing the anastomosis? A prospective randomized trial.
Introduction: The risk of developing pelvic pain after radical prostatectomy is clinically significant. Multiple predisposing and perioperative factors were discussed. The aim of this study was to compare the use of two different suture materials for the anastomosis and its effect on postoperative pelvic pain and anastomotic leakage.
Methods: We prospectively randomized patients in a 1:1 ratio to a monofilament bidirectional polyglycolic-polycaprolactone suture with an anchoring system (Stratafix 4-0, Johnsen&Johnson) and RB-1 needle shape (MS) versus a braided, double armored polydioxanon suture (PDS 2-0, Johnsen&Johnson) with UR-6 needle shape (BS). All included patient underwent laparoscopic robot-assisted radical prostatectomy with continuously sutured anastomosis analogue the Van Velthoven technique. We prospectively assessed pelvic pain using the validated EPIC-26 questionnaire at 3 months postoperatively and tested for anastomotic leakage performing cystography at the sixth postoperative day.
Results: In this preliminary analysis, 191 patients with a median age of 67 years (interquartile range [IQR] 62 - 72) were eligible for analysis; 96 in the MS group and 95 in the BS group. The median operation was 219 and 218 minutes, respectively.
Sixty-two versus 63 patients underwent extended lymph node dissection and 68 versus 78 patients underwent non-nerve-sparing procedure among the MS and BS study groups, respectively. Of the MS and BS groups, 39 and 37 patients had locally advanced disease (T3/4, N+) in final pathology. Five patients sutured with MS and 9 patients sutured with BS suffered from pelvic pain at 3 months. Intraoperative anastomotic leakage was observed in 5 and 10 patients, respectively. The use of either suture material was not associated with postoperative pelvic pain (p=0.3), nor with anastomotic leakage (p=0.16).
Conclusions: No significant difference between PDS and Stratafix on postoperative pelvic pain and anastomotic leakage was observed. So far we conclude, that the surgeon should select the suture material according to his preference.
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