Transcript Document

Laparoscopic Radical Prostatectomy: Oncological and Functional Outcomes
Following Fellowship Training.
T.R.J. Gianduzzo*, C. Chabert†, L. Osgood†.
*The
No. 091
Wesley Hospital, Brisbane, Qld; †John Flynn Hospital, Tugun, Qld; †Lismore Base Hospital, Lismore, NSW.
Introduction
Radical Prostatectomy (RP) is a technically demanding procedure that
has a significant learning curve irrespective of whether it is performed
open, laparoscopically or robotically. Fellowship training aims to
reduce that curve and improve operative outcomes. We present the
initial series of laparoscopic radical prostatectomy (LRP) by 2
fellowship-trained surgeons TRJG and CC.
Preoperative Gleason grades were Gleason 6 (13%), Gleason 7
(74%) and Gleason 8-10 (13%). Nerve-sparing surgery was
performed in a total of 72% of patients. This was unilateral in 32% and
bilateral in 68%. Final pathological stage was pT2 (58%), pT3 (42%).
The positive margin rates for pT2 disease was 1.1% and for pT3
disease was 32.8%. Five patients received planned adjuvant
radiotherapy for high volume pT3 disease. There was 1 PSA failure.
Pad Free Rates (%)
Aim
The aim of this paper is to present the initial results of 2 fellowshiptrained surgeons in LRP following return from international fellowship
training in comparison with published series of open (ORP), LRP and
robotic-assisted RP (RARP).
100
At 1 week 28% of patients
were pad free. Pad free rates
at 3, 6, 9 and 12 months were
67%, 86%, 91% and 95%.
90
80
70
60
50
40
30
20
Methods
10
0
Data was collected prospectively. Any patient who was a candidate
for RP was considered a candidate for LRP. All patients underwent a
5-port extraperitoneal antegrade dissection. Nerve-sparing was
performed using a strictly athermal technique. Potency data was
collected using the Sexual Health Inventory for Men (SHIM) score.
Continence was defined as pad-free rates. Positive surgical margin
(PSM) was defined as cancer at the inked margin in accordance with
the International Society of Uro-pathologists (ISUP) definition.
Results
A total of 152 patients had undergone LRP with a median follow-up of
6 months. The median age and BMI was 61 (44-74) years and 27 (2037) kg/m2 respectively. Median pre-operative PSA was 6.1 (0.7-30)
ng/ml. Preoperative clinical stage was cT1a (7%), cT1c (42%) and
cT2 (51%).
1 wk
3m
6m
9m
12 m
Comparison with Published Series
LRP
TRJG/CC
RARP3
ORP1,2
pT2 PSM (%)
1.1
2.5-18
6-36.7
Continence (%)
95
70-97
31-97.7
Potency (%)
83
67.8-93
21-90
Conclusions
Fellowship training in LRP has afforded low positive margin rates and
high continence and potency rates and compares favourably to
published series of ORP, LRP and RARP. This suggests that training,
rather than the technique used is the main predictor of operative
outcomes.
References
1. Ficarra V, Novara G, Artibani W, et al: Retropubic, laparoscopic, and robotassisted radical prostatectomy: a systematic review and cumulative analysis of
comparative studies. Eur Urol. 2009;55(5):1037.
2. Herrmann TR, Rabenalt R, Stolzenburg JU, et al: Oncological and functional
results of open, robot-assisted and laparoscopic radical prostatectomy: does
surgical approach and surgical experience matter? WorldJUrol. 2007;25(2):149.
3. Coelho RF, Chauhan S, Palmer KJ, et al: Robotic-assisted radical
prostatectomy: a review of current outcomes. BJU Int. 2009;104 (10):1428.
Bilateral Nerve Spare Potency Rates (%)
By 6 weeks postoperatively 50% of preoperatively potent patients
with bilateral nerve-sparing
(B N S ) p r oc ed u r es h ad
achieved penetrative
intercourse while at 1 year
83% were potent.
90
80
70
60
50
40
30
20
10
0
6 wk
3m
6m
9m
12 m
Sponsored by: