Our Laparoscopic Radical Prostatectomy Experiences: Single Center Results

Year 2017, Volume: 1 Issue: 3, 135 - 138, 15.12.2017

Murat Uçar Ali Akkoç Taylan Oksay Tahsin Çapkın Sedat Soyupek Alim Koşar

https://doi.org/10.30565/medalanya.340737

Abstract

Aim: The aim of the study
is to evaluate the characteristics and oncological and functional outcomes of
patients operated with laparoscopic radical prostatectomy surgery at Our Clinic

Patients and Method:
23 radical prostatectomy cases performed entirely laparoscopically at Our
Clinic between 2008 and 2011 were reviewed retrospectively. Preoperative
characteristics, perioperative and postoperative complications of the patients
their treatments, and biochemical recurrence rates were evaluated.

Results: Postoperative
prostatectomy pathologies of patients were 3 + 3 in 19 (82.6%) patients, 3 + 4
in 3 (13%) patients and 4 + 3 in 1 (4.3%) patient. The surgical margin was
positive in 5 (21.7%) patients. According to TNM 2009 staging, the pathology of
4 (17,3%) patients were T2a, 13 (56,5%) patients were T2c, 5 (21,7%) patients
were T3a, and 1 (4,3%) patient was T3b. Postoperative anastomosis leakage
occurred in 2 (8.6%) patients and vesicorectal fistula occurred in 1 (4.3%)
patient. In 15 (65.2%) patients erectile dysfunction (ED) developed
postoperatively. 5 (21.7%) patients were re-operated due to anastomotic
stricture. Biochemical recurrence was detected in 3 (13%) patients after
postoperative 1 year (prostate specific antigen (PSA) value > 0.2ng/ml).

Conclusion:
The results of open retropubic radical prostatectomy (RRP) and laparoscopic
radical prostatectomy (LRP) are similar in terms of oncologic and functional
outcomes. However, because of the learning curve in LRP is long, in the first
series operation period is longer than RRP. After completing the learning
curve, LRP is a more advantageous surgical technique than RRP in terms of
postoperative pain, needing for blood transfusion, and duration of hospital stay.

Keywords

Prostate Cancer, Laparoscopy, Radical Prostatectomy

Laparoskopik Radikal Prostatektomi Deneyimlerimiz: Tek Merkez Sonuçları

Abstract

Amaç: Kiliniğimizde
laparoskopik radikal prostatektomi operasyonu yapılan hastaların özellikleri
ile onkolojik ve fonksiyonel sonuçlarının değerlendirilmesi.

Hastalar
ve Yöntem:
Kliniğimizde 2008-2011 yılları arasında baştan sona laparoskopik olarak yapılan
23 radikal prostatektomi vakası  retrospektif olarak
tarandı.  Hastaların preoperatif özellikleri, perioperatif ve
postoperatif komplikasyonları ve bunların tedavileri, biyokimyasal nüks
oranları incelendi.

Bulgular: Hastaların operasyon
sonrası prostatektomi patolojileri 19 hastada Gleason skoru 3+3 (%82,6), 3
hastada 3+4 (%13), 1 hastada 4+3 (%4,3) olarak geldi. Cerrahi sınır 5
(%21,7)  hastada pozitif (+) olarak
tespit edildi. TNM 2009 evrelemesine göre 4 (%17,3) hastanın patolojisi T2a, 13
(%56,5) hastanın T2c, 5 (%21,7) hastanın T3a, 1 (%4,3) hastanın T3b olarak
geldi.  İki (%8,6) hastada postoperatif
anastomoz kaçağı meydana gelmiş, 1 (%4,3) hastada ise vezikorektal fistül
meydana gelmiştir. On beş (%65,2) hastada postoperatif dönemde erektil
disfonksiyon (ED) gelişmiştir. Beş (%21,7) hasta anastomoz darlığı nedeniyle
tekrar opere edilmiştir. Postoperatif 1. yılda 3 (%13) hastada biyokimyasal
nüks saptanmıştır (prostat spesifik antijen (PSA) değeri >0,2 ng/ml). 

Sonuç: Onkolojik ve fonksiyonel sonuçlar
açısından bakıldığında açık retropubik radikal prostatektomi (RRP) ve
laparoskopik radikal prostatektomi (LRP) sonuçları benzerdir. Ancak LRP’de
öğrenme eğrisi uzun olduğu için operasyon süresi ilk serilerde RRP’den daha
uzundur. Öğrenme eğrisi tamamlandıktan sonra LRP postoperatif ağrı, kan
transfüzyonu ihtiyacı, hastanede kalış süresi açısından RRP’ye göre daha
avantajlı bir cerrahi tekniktir.

Keywords

Prostat Kanseri, Laparoskopi, Radikal Prostatektomi

References

• 1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5):E359-386.
• 2. Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. The Cochrane database of systematic reviews. 2017; 9:Cd009625.
• 3. Rassweiler J, Sentker L, Seemann O, Hatzinger M, Rumpelt HJ. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol. 2001;166(6):2101-2108.
• 4. Salomon L, Rozet F, Soulie M: [Surgery of prostate cancer: Technical principles and perioperative complications]. Prog Urol. 2015; 25(15):966-998.
• 5. Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016; 388(10049):1057-1066.
• 6. Allan C, Ilic D. Laparoscopic versus Robotic-Assisted Radical Prostatectomy for the Treatment of Localised Prostate Cancer: A Systematic Review. Urol Int. 2016; 96(4):373-378.
• 7. Coelho RF, Rocco B, Patel MB, Orvieto MA, Chauhan S, Ficarra V, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol. 2010; 24(12):2003-2015.
• 8. Mason S, Van Hemelrijck M, Chandra A, Brown C, Cahill D. Laparoscopic radical prostatectomy outcome data: how should surgeon's performance be reported? A retrospective learning curve analysis of two surgeons. Ecancermedicalscience. 2016; 10:651.
• 9. Tang KQ, Pang SY, Bao JM, Lei CY, Tan WL.Three-dimensional versus two-dimensional imaging systems in laparoscopic radical prostatectomy for prostate cancer: a retrospective cohort study. Nan fang yi ke da xue xue bao = Journal of Southern Medical University. 2017; 37(1):1-5.
• 10. Bove P, Iacovelli V, Celestino F, De Carlo F, Vespasiani G, Finazzi Agro E. 3D vs 2D laparoscopic radical prostatectomy in organ-confined prostate cancer: comparison of operative data and pentafecta rates: a single cohort study. BMC Urol. 2015; 15:12.
• 11. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009; 55(5):1037-1063.
• 12. Alessandro S, Alessandro G, Susanna C, Michele I, Francesca DQ, Andrea F, et al. Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results. Int Braz J Urol. 2016; 42(2):223-233.
• 13. Salonia A, Castagna G, Capogrosso P, Castiglione F, Briganti A, Montorsi F. Prevention and management of post prostatectomy erectile dysfunction. Transl Androl Urol. 2015; 4(4):421-437.
• 14. Ramsay C, Pickard R, Robertson C, Close A, Vale L, Armstrong N, et al. Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technol Assess (Winchester, England). 2012; 16(41):1-313.
• 15. Kishimoto N, Takao T, Yamamichi G, Okusa T, Taniguchi A, Tsutahara K, et al. Impact of prior abdominal surgery on the outcomes after robotic - assisted laparoscopic radical prostatectomy: single center experience. Int Braz J Urol. 2016; 42(5):918-924.