Contemporary Laparoscopic and Open Radical Retropubic Prostatectomy: Pathologic Outcomes and Kattan Postoperative Nomograms Are Equivalent

[Prospective study and comparative of surgical and oncologic outcome between laparoscopic and retropubical radical prostatectomy]

INTRODUCTION

Radical prostatectomy (RP) is a potentially healing surgical procedure.

OBJECTIVE

We evaluate and compare the surgical and oncologic outcomes between laparoscopic and retropubical radical prostatectomy in the Urology Department in DIPRECA Hospital.

METHOD

We constructed a nonrandomised, prospective study between january 2003 and march 2007. A total of 115 patients, 56 operated laparoscopically and 59 by retropubical RP. Functional and oncologic results were compared according to standardized variables and their corresponding statistical analysis, for which we used SPSS 12.0 program.

RESULTS

Mean operation time was 202,5 minutes for laparoscopic RP and 150,5 for retropubical RP (p<0.0001). Retropubical RP required more blood transfusions (p<0.0001), longer hospital stay (p=0,0073) and longer need for vesical catheter (p=0,0001) than laparoscopic RP. There were 23 complications, 15 attributable to laparoscopic RP. We found no significant differences in postsurgical sexual function and urinary continence. In respect to the oncologic variables, we found no statistically relevant differences in positive surgical margins nor biochemical relapse during follow up.

CONCLUSION

We found no significant differences between retropubical and laparoscopic RP in the oncologic and functional variables analyzed. Nevertheless, our experience shows a distinct benefit in favour of the laparoscopic approach in relation to bleeding and recovery rate. Though retropubical RP has a shorter operating time, we believe this variable depends on the learning curve still developing for laparoscopic RP. According to our literary review, this is the first publication in Chile that compares both techniques.

Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases

BACKGROUND

Robot-assisted laparoscopic radical prostatectomy (RALP) is an evolving minimally invasive treatment of for localized prostate cancer. We present our experience of 1500 consecutive cases with an analysis of perioperative outcomes.

PATIENTS AND METHODS

Fifteen hundred consecutive RALPs were performed by a single surgeon (VRP). Following Institutional Review Board approval, clinical coordinators performed prospective intraoperative and postoperative data collection. Functional outcomes were assessed using validated self-administered questionnaires.

RESULTS

Mean OR time from skin incision to fascial closure (the time that the surgeon was present) was 105 minutes (55-300). Mean EBL was 111 cc (50-500). Ninety-seven percent of patients were discharged home on postoperative day 1. The overall complication rate was 4.3% with no mortalities. The positive margin rate (PMR) was 9.3% overall. PMR was 4% for pT2, 34% for T3 and 40% for pathologic stage T4.

CONCLUSIONS

Our initial series represents one of the largest published series for perioperative outcomes of robotic assisted prostatectomy. Our data demonstrates the feasibility, safety and efficacy of the procedure.

Large pelvic arteriovenous malformation complicating laparoscopic radical prostatectomy

Pelvic arteriovenous malformations (AVM) are rare, usually congenital, lesions, which can pose significant difficulties for pelvic surgeons. We present a case of an AVM complicating laparoscopic radical prostatectomy. Unexpected failure of preoperative control led to significant intraoperative difficulty. The advantages of an antegrade approach and optimal magnification afforded by the laparoscopic approach led to successful completion of the operation with minimal morbidity.

[Oncological and functional results of total prostatectomy: an objective open analysis versus laparoscopy]

Based on a systematized literature analysis, laparoscopic radical prostatectomy is associated with less peroperative blood loss than open surgery. Operative time is shorter using an open approach. In terms of cancer control and functional results, no difference was found between both approaches.