Oncological outcome of laparoscopic prostatectomy

Abstract

Aim: Oncological outcomes including surgical margin status and biological progression-free survival (bPFS) were analyzed in patients who underwent laparoscopic prostatectomy (LRP) only. Methods: A total of 136 patients who underwent LRP only without lymph node metastasis or perioperative supportive therapy between April 2000 and October 2005 were analyzed. All patients received Ն6 months postoperative follow-up. Biological progression was defined as elevation of prostate-specific antigen by >0.2 ng/mL. Results: The positive margin (ew+) rate was 36.8% and the 3-year bPFS was 72.6% for all patients. Positive margin rates in pT2a-b, pT2c, pT3a and pT3b were 10.0%, 27.5%, 77.3% and 53.8%, respectively. Three-year bPFS rates in pT2, pT3a and pT3b were 91.8%, 66.8% and 44.9%, respectively. Although the positive margin rate at posterior and anterior sites decreased as more patients were recruited , no significant improvements were observed at apex and base sites. Three-year bPFS rates in pT2 ew-, pT2 ew+, pT3 ew-and pT3 ew+ were 95.8%, 85.7%, 81% and 48.5%, respectively, indicating that positive margins exert a greater impact in pT3 disease than in pT2 disease. Conclusions: Although 3-year bPFS results were almost identical to previous reports of LRP and retropubic radical prostatectomy, the positive margin rate in pT3a disease was particularly high, probably due to immature surgical skill. Although positive margins at posterior and anterior sites decreased with the leaning curve, improvements are needed to reduce positive margin rates at the apex. Positive margins exert greater impact in pT3 disease than in pT2 disease.

Laparoscopic radical prostatectomy: oncological and functional results of 126 patients with a minimum 3-year follow-up at a single Chinese institute

“…Notably, the functional outcomes in this study seem to be better than those of several previous reports [22][23][24][25]. Although wide disparity exists in the reported continence and erectile function after LRP, which could result from differing definitions of continence and erectile function, surgical techniques and qualityof-life instruments used, there is possible observerreceiver bias when evaluating the functional results by outpatient or telephone interviews.…”

“…bPFS might offer a better index of oncological outcome. Previous series of LRP reporting bPFS are shown in Table 5 and are compared with large ORP series [18,[22][23][24][27][28][29]. The bPFS rates in the present series at 3-year followup, of 90% for pT2, 61% for pT3a and 43.0% for pT3b, respectively, are comparable with both open and laparoscopic series with a similar duration of follow-up.…”

“…The operative duration decreased significantly with experience. Although there is still much room for improvement, our average operative time of 250 min and blood loss of 354 mL compared favorably with the average operative time of 403 min and blood loss of 856 mL in a larger Asian series [24]. The four major complications seen in the first 30 patients of our series are a testament to the technical difficulty of this procedure.…”

“…The reported rates of urinary continence after LRP compare favorably with those in large series of ORP, which have been reported to be 80%-95%. Although the definition of urinary continence varies among the reported series, the incidence of requiring no pads after LRP was 83%-100% at 1 year [22][23][24][25]. In a prospective comparison of 70 patients with ORP and 230 with LRP, there was no significant difference in continence at 1 year, but patients undergoing LRP had an earlier return to continence [23].…”

“…The oncological data available from comparative studies show that LRP apparently gives results of similar percentages of PSM to those of ORP [18][19][20][21][22][23][24][25][26][27][28][29][30] (Table 4). The PSM rates for LRP in pT2 and pT3 disease were 7.4%-27.5% and 17.2%-77.3%, respectively, and for ORP in pT2 and pT3 disease were 3.3%-18.8% and 19.3%-53%, respectively.…”