Head‐to‐head comparison of retropubic, perineal and laparoscopic radical prostatectomy

Abstract

Objective: As more patients are diagnosed with prostate cancer at an early stage, it is becoming increasingly important to refine the technique of surgical excision. For this purpose we have generated objective data comparing three different surgical approaches used by three experienced surgeons. Methods: We prospectively compared three contemporary personal series of 50 consecutive radical prostatectomy (RP) patients. The healthrelated quality of life was evaluated preoperatively and in months 1, 3, 6, 12 and 24.Results: Considering in turn the patients undergoing retropubic, perineal and laparoscopic RP, the median procedure time was 2 h and 27 min, 1 h and 50 min and 4 h, with a transfusion rate of 2, 0 and 8%, respectively. In the perineal group there were more wound infections. Median catheter drainage was 7, 10 and 7 days and zero, 13 and one patients needed reinsertion of a catheter. Early continence varied considerably, with 57.4, 11.4 and 6.3% of patients pad-free after 1 month, but there were no differences in social continence (zero or one pad) with 97.8, 97.8 and 91.9% after 2 years. The Litwin score for incontinence (preoperative minus postoperative) was -24, -41 and -63% after 1 month and -13, +3 and -29% after 2 years. Twenty-nine, five and 15 patients had a preoperative five-item version of International Index of Erectile Function (IIEF-5) score of Ն17 points and a nerve-sparing procedure. After 2 years, 48.1, 0 and 0% had an IIEF-5 score of Ն17 points without the use of phosphodiesterase type 5 (PDE-5) inhibitors, but when including patients using inhibitors there were no significant differences. Conclusions: A comparison of morbidity, short-term convalescence and long-term side-effects of different surgical techniques is strongly biased by both the preoperative status of patients and the skill of the surgeons. Overall, we found some differences in the short-term results (e.g. early continence) and comparable long-term results.

Defining potency: A comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite

“…17 Various studies have reported erectile function outcomes after radical prostatectomy, 18 brachytherapy, 19 or external-beam radiotherapy with or without brachytherapy 20,21 using the IIEF-5. Many more studies have used the EPIC to assess ED in prostate cancer patients.…”

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.

“…61 Similarly, the total volume of cancer identified by pathological examination of the whole prostate after radical prostatectomy has been assessed as a possible predictive factor for recurrence but was found not to be independently significant on multivariate analysis. 62 These pathological measures of cancer extent have not been included in our care pathway given the current uncertainty of the evidence base.…”

“…All studies reported age with a median (interquartile range) of 62 (60)(61)(62)(63)(64) years and a total range of 35-84 years.…”

Radical perineal prostatectomy in patients with prostate cancer: methodological aspects and results

“…В мире накоплен большой опыт выполнения РППЭ больным РПЖ. Благодаря на-копившемуся опыту хирургов частота осложнений после РППЭ в последние годы значительно снизилась [3][4][5].…”

“…N. Schmeller и соавт. [5] сравнили результаты позадилонной, промежностной и лапароскопической РПЭ. Среднее время операции соста-вило 147, 110 и 240 мин соответственно.…”