Early prostate-specific antigen failure following radical perineal versus retropubic prostatectomy: the importance of seminal vesicle excision

Theodorescu, Dan; Lippert, Marguerite C.; Broder, Stanford R.; Boyd, James C.

doi:10.1016/s0090-4295(97)00495-0

Cited by 28 publications

(8 citation statements)

References 18 publications

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“…A radical prostatectomy can be accomplished through either a retropubic3 or perineal4, 5 approach. Based on the number of recent literature citations, the perineal approach to radical prostatectomy has regained some of the popularity6, 21–23 it enjoyed in the past. Data from several groups indicate excellent freedom from PSA recurrence in patients treated with this approach 6, 21.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the number of recent literature citations, the perineal approach to radical prostatectomy has regained some of the popularity6, 21–23 it enjoyed in the past. Data from several groups indicate excellent freedom from PSA recurrence in patients treated with this approach 6, 21. Although Harris and Thompson21 reported that PSA is detectable postoperatively in 2% and 4% of pT2 and pT2 to T3b cases, respectively, at an average follow‐up of 1 year, a recent study demonstrated that care must be taken in the complete excision of the seminal vesicles for biochemical failure rates to remain comparable to those of the retropubic approach 6.…”

Section: Discussionmentioning

confidence: 99%

“…In the present cost‐conscious environment of health care, a critical analysis of medical expenditures has led to the alteration of medical practice and the development of care pathways2 that have increased the efficiency of medical practice. Because radical prostatectomy can be accomplished through either a retropubic3 or perineal4, 5 approach, with each being associated with a somewhat different spectrum of side effects,6, 7 variables believed to contribute to LOS need to take the surgical approach used into account.…”

mentioning

confidence: 99%

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Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy

Gardner

Bissonette

Petroni

et al. 2000

Cancer

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BACKGROUND Radical prostatectomy continues to comprise the mainstay of therapy for localized prostate carcinoma. However, caring for radical prostatectomy patients accounts for approximately half of the $1.7 billion annual cost of prostate carcinoma treatment. Length of stay (LOS) after surgery appears to be one of the main components of this cost. The first step in reducing cost is to identify those variables associated with LOS. Radical prostatectomy can be performed using two very different surgical techniques and with each technique different costs are incurred. The objective of the current study was to identify factors associated with LOS as a function of surgical approach. To reduce potential biases due to patient requests for longer hospitalization or physician preferences in that regard, secondary objectives were to identify factors associated with time to fluid intake (TTF) and time to consume solid foods (TTS). METHODS An institutional‐based, retrospective chart review of 313 men with clinically localized prostate carcinoma who underwent either a perineal (RPP) or retropubic (RRP) prostatectomy at a single university center from March 1988 to October 1996 was undertaken. Information regarding LOS was available for 311 patients. Linear regression models were used to assess the association between covariables and LOS. Poisson regression models for count data were used to assess associations between covariables and the secondary endpoints of TTF and TTS. Covariables included: preoperative (age, race, prostate specific antigen, Gleason score, clinical stage, lymph node resection, comorbidity, and admission time), intraoperative (surgical approach, surgeon, operative time, estimated blood loss, transfusion requirement, anesthetic approach, and American Society of Anesthesiologists score), and postoperative (pain management complications and transfusions) parameters. RESULTS The median LOS was 4 days (range, 1–19 days) for RPP and 5 days (range, 3–16 days) for RRP approaches. The final model included six main effects and three interaction terms. Overall, LOS decreased over time with LOS decreasing at a faster rate in patients who underwent RPP. In general, patients who underwent RRP had an increased LOS compared with patients who underwent RPP. Complications from surgery and age increased the LOS for all patients; however, the increase was greater in patients who underwent RPP. In addition, the use of intraoperative epidural anesthesia and the increased use of postoperative narcotics were associated with increased LOS for patients undergoing both surgical approaches. TTF and TTS were significantly longer for patients who underwent the retropubic approach compared with those patients who underwent the perineal approach. After adjustment for surgical approach no other covariables were found to be associated with TTF. After adjustment for surgical approach, the occurrence of complications was found to be associated with TTS, indicating that patients who experienced complications took longer before they ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy

Gardner

Bissonette

Petroni

et al. 2000

Cancer

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“…At Wve and ten years postoperatively, 38 and 25.6% of men with pT3b disease were free of biochemical recurrence in a multi institutional study of 6,740 patients [14]. Another study by Theodorescu et al strengthens the argument for complete excision of the seminal vesicles [15]. They demonstrated a higher biochemical recurrence rate in men with incomplete excision of the seminal vesicles when compared with those who underwent complete seminal vesicle excision.…”

Section: Discussionmentioning

confidence: 93%

Robot-assisted laparoscopic radical prostatectomy: an athermal anterior approach to the seminal vesicle dissection

et al. 2008

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The seminal vesicles, particularly the lateral aspect and tips, are among the closest structures to the cavernous nerves and pelvic plexus. Given this proximity it is essential that the seminal vesicle dissection be performed in an athermal and atraumatic fashion during robot-assisted laparoscopic prostatectomy (RALP). Traditionally the seminal vesicle dissection during RALP is performed by dividing the vas deferens and following it proximally to locate the tip of the seminal vesicle. Here we describe a modification to the traditional anterior approach to seminal vesicle dissection. Our modification allows the dissection to be performed athermally and efficiently with use of minimal traction. The dissection proceeds medially between the two terminal vas deferens to identify the medial surface of one of the seminal vesicles. This medial surface is avascular and can be developed easily along the length of the vesicle using blunt dissection. Once its tip is identified it is elevated with the fourth arm medially between the two vas deferens. The ipsilateral vas can then be clipped and divided below the level of the elevated seminal vesicle. The vascular supply to the seminal vesicle is then simply identified entering the lateral aspect of its tip. A hemolock clip is placed directly beneath the tip of the seminal vesicle to control its vasculature. The remainder of the dissection can be performed with sharp dissection. Using this technique the seminal vesicle can be excised entirely with minimal traction and no thermal energy. By elevating the tip medially away from the location of the pelvic plexus and cavernous nerves, inadvertent damage to these neural structures is avoided when placing the hemolock clips.

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“…25 In addition, at least two reports have found perineal prostatectomy to be inferior to the retropubic approach as a cancer operation. Theodorescu and colleagues 26 documented higher PSA recurrence rates (45%) after perineal prostatectomy compared with retropubic prostatectomy (18%) in a retrospective nonrandomized study. In another study, 21 surgically induced positive margins were more common in the perineal group (43%) than in the retropubic group (29%).…”

Section: Radical Prostatectomymentioning

confidence: 95%

The Treatment of Prostate Cancer. . An Overview of Current Options

Pirtskhalaishvili

Hrebinko²,

Nelson³

2001

Cancer Pract

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The availability of several therapeutic options for localized prostate cancer warrants careful consideration when planning treatment with curative intent. Patients need to be active participants in decision making, and they must be aware of the benefits and possible complications of the different types of treatment. Patients with advanced prostate cancer need to be aware that hormone treatment will provide temporization and palliation in the majority of cases. Hormone-resistant prostate cancer is refractory to most forms of conventional and experimental therapy.

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Early prostate-specific antigen failure following radical perineal versus retropubic prostatectomy: the importance of seminal vesicle excision

Cited by 28 publications

References 18 publications

Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy

Surgical and postoperative factors affecting length of hospital stay after radical prostatectomy

Robot-assisted laparoscopic radical prostatectomy: an athermal anterior approach to the seminal vesicle dissection

The Treatment of Prostate Cancer. . An Overview of Current Options

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