Laparoscopic Radical Prostatectomy - the Experience of the German Laparoscopic Working Group

Rassweiler, Jens; Stolzenburg, J.U.; Sulser, Tullio; Değer, Serdar; Zumbé, J.; Hofmockel, G.; John, Hubert; Janetschek, G.; Fehr, J.; Hatzinger, Martin; Probst, M.; Rothenberger, K; Poulakis, Vassilis; Truß, Michael C.; Popken, G.; Westphal, J.; Alles, Uwe; Fornara, Paolo

doi:10.1016/j.eururo.2005.10.003

Cited by 138 publications

(81 citation statements)

References 17 publications

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“…The PSM rate was 10.6% (3.2 -18%) for pT2 and 32.7% (20 -38.5%) for pT3a tumours. The mean (range) 5-year BCR-free survival was 91.4 (84.7 -96) % for pT2 and 82.5 (79.4 -85) % for pT3a stages [ 11 ] . With respect to UI, the present results are similar.…”

Section: Discussionmentioning

confidence: 99%

Long‐term oncological and continence outcomes after laparoscopic radical prostatectomy: a single‐centre experience

et al. 2012

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E 9 8 5What ' s known on the subject? and What does the study add? Over the past decade, minimally invasive laparoscopic radical prostatectomy and more recently robot-assisted laparoscopic prostatectomy have been introduced and have proven equally effective compared with open surgery in terms of mid-term cancer control and complication rates. Because long-term data is lacking, open prostatectomy is still considered the ' gold standard ' by some authors, who argue that minimally invasive approaches have to measure up to the excellent long-term results of open surgery.This study represents one of the largest series (1845 patients) of minimally invasive radical prostatectomy with extended follow-up (11.3 years) and detailed data on oncological outcome and postoperative incontinence. It therefore supplies previously lacking information on these details for minimally invasive prostate surgery and provides important information for patient counselling. OBJECTIVE• To investigate biochemical recurrence (BCR) rates and data on postoperative incontinence in a large laparoscopic radical prostatectomy (LRP) cohort with extended follow-up. MATERIALS AND METHODS• BCR and independent predictors of BCR were identifi ed using Kaplan -Meier and Cox regression analysis of 1845 patients who underwent LRP from 1999 to 2007.• Urinary incontinence was evaluated by pads per day and stratifi ed as follows: 0 -1 pad: no incontinence; 2 -3 pads: mild incontinence; and ≥ 3 pads: severe incontinence. RESULTS• Organ-confi ned disease, extraprostatic extension, seminal vesicle invasion and lymph node metastasis were present in 71.3%, 20.5%, 6.7% and 3.2% of patients, respectively. The positive surgical margin rate was 29.2%.• Postoperatively, 74.9% of the patients were continent, while 9.2% had mild and 15.9% severe incontinence.• The mean follow-up was 5 years with a maximum follow-up of 11.3 years.• There were 51 overall deaths and six deaths from prostate cancer. The 5-year, 8-year and 10-year BCR-free survival rates were 83.9%, 78.6% and 75.6%, respectively.• On univariate analyses preoperative D ' Amico risk classifi cation, pathological tumour stage, postoperative Gleason sum and surgical margin status were predictors of BCR ( P < 0.001).• On multivariable analysis, D ' Amico classifi cation, Gleason sum ( P < 0.001), postoperative tumour stage ( P < 0.001), nodal status ( P < 0.001) and surgical margin status ( P = 0.002) were independent predictors of BCR. CONCLUSIONS• LRP offers excellent long-term functional and oncological results with a low incidence of BCR for patients with localized disease.• These results could be used for patient counselling before robot-assisted laparascopic prostatectomy (RALP) until long-term follow-up data for RALP is available. KEYWORDSlaparoscopy , prostatectomy , localized prostate cancer , long-term outcome Study Type -Therapy (case series) Level of Evidence 4

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Section: Discussionmentioning

confidence: 99%

Long‐term oncological and continence outcomes after laparoscopic radical prostatectomy: a single‐centre experience

et al. 2012

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“…The potency rates for RRP, LRP, and RARP are detailed on Table 10 17,23,24,32-34,59,60,65-68 Table 11, 33,38,40,41,[44][45][46]62,69 and Table 12. 35,48,51,53,63,64 As for continence, comparisons of the potency rates between different series are extremely difficult.…”

Section: Potency Outcomesmentioning

confidence: 99%

“…The pathologic stage and PSM rates for open, RLP, and RARP series are summarized on Table 4, 16-22,24-28,30,31,33,55-57 Table 5, 33,37,38,[40][41][42][44][45][46][47] and Table 6, 30,31,35,[48][49][50][51][52][53][54]58 respectively. The pathologic stage in the RARP series was of 78.2% pT 2 tumors and 20.5% pT 3 tumors.…”

Section: Oncologic Outcomesmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

246

149

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Purpose: To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robotassisted radical prostatectomy (RARP) currently available in the literature. Methods: A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms ''prostatectomy'' and ''Outcome Assessment (Health Care)'' and text words ''retropubic,'' ''robotic,'' and ''laparoscopic.'' Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. Results: We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. Conclusion: RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.

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“…adhesions, difficulties with the urethro-vesical anastomosis, malfunctioning of instruments) or uncertain tumor anatomy (i.e. risk of positive margins) caused the conversion to open surgery rather than intraoperative complications, such as bleeding or visceral injury (15). Bhayani et al observed only 1.9% incidence of open conversions in a multi-institutional series citing prior pelvic surgery and morbid obesity as contributing factors (18).…”

Section: Intra-and Perioperative Complicationsmentioning

confidence: 99%

“…In 2004, 19.2% of German departments already offered LRP, whereas 26.9% preferred perineal, and 60.6% retropubic radical prostatectomy (14). In 2006, a multi-center study of more than 5800 patients was published treated with LRP by 50 surgeons in Germany (15).…”

Section: Historical Aspectsmentioning

confidence: 99%

Laparoscopic radical prostatectomy: a review

et al. 2009

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Introduction:We offer an overview of the intra-, peri-and postoperative outcomes of laparoscopic radical prostatectomy (LRP) with the endpoint to evaluate potential advantages of this approach. Materials and Methods:We conducted an extensive Medline literature search (search terms "laparoscopic radical prostatectomy" and "radical prostatectomy") from 1990 until 2007. Only full-length English language articles identified during this search were considered for this analysis. A preference was given to the articles with large series with more than 100 patients. All pertinent articles concerning localized prostate cancer were reviewed. Conclusion: Pure LRP has shown to be feasible and reproducible but it is difficult to learn. Potential advantages over open surgery have to be confirmed by longer-term follow-up and adequately designed clinical studies.

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Laparoscopic Radical Prostatectomy - the Experience of the German Laparoscopic Working Group

Cited by 138 publications

References 17 publications

Long‐term oncological and continence outcomes after laparoscopic radical prostatectomy: a single‐centre experience

Long‐term oncological and continence outcomes after laparoscopic radical prostatectomy: a single‐centre experience

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Laparoscopic radical prostatectomy: a review

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