Laparoscopic radical prostatectomy for high‐risk prostate cancer

Abstract

ObjectiveTo investigate the results of performing laparoscopic radical prostatectomy (LRP) in patients with high-risk prostate cancer (HRPC): PSA level of ≥20 ng/mL ± biopsy Gleason ≥8 ± clinical T stage ≥2c. Patients and MethodsOf a total of 1975 patients having LRP during a 159-month period from 2000 to 2013, 446 (22.6%) had HRPC; all patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning. The median (range) patient age was 64.0 (36-79) years; body mass index 27.0 (18-43) kg/m 2 ; PSA level 8.1 (0.1-93) ng/mL and biopsy Gleason 8 (6-10). All patients had a pelvic lymphadenectomy, which was done using an extended template after April 2008 (53.3%). Neurovascular bundle (NVB) preservation was done in 41.5% (bilateral 26.3%; unilateral 15.2%) of patients; an incremental or partial nerve-sparing technique was used in 99 of the 302 (32.8%) NVBs preserved. ResultsThe median (range) gland weight was 58.5 (20-161) g; operating time 180 (92-330) min; blood loss 200 (10-1400) mL; postoperative hospitalisation 3.0 (2-7) nights; catheterisation time 14 (2-35) days; complication rate 7.6%; lymph node (LN) count 16 (2-51); LN positivity 16.2%; LN involvement 2 (1-8); positive surgical margin (PSM) rate 26.0%; up-grading 2.5%; down-grading 4.3%; up-staging from T1/2 to T3, 24.7%; down-staging from T3 to T1/2, 6.1%. No cases were converted to open surgery and three patients were transfused (0.7%) after surgery. At a mean (range) follow-up of 24.9 (3-120) months, 79.2% of patients were free of biochemical recurrence, 91.8% were continent and 64.4% of previously potent non-diabetic men aged <70 years were potent after bilateral nerve preservation. ConclusionThe low morbidity, 55.4% specimen-confinement rate, 26.0% PSM rate, 79.2% biochemical disease-free survival, 91.8% continence rate and 64.4% potency rate, at 35.2 months in the present study serve as evidence firstly that surgery is an effective treatment for patients with HRPC, curing many and representing the first step of multi-modal treatment for others, and that LRP for HRPC appears to be as effective as open RP in this context.

Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy

“…This is reflected in the fact that 35.5% of our patients were found to have T3 or T4 disease. Stratifying patients by pathological stage, the PSM rate in patients with pT2 disease (17.8%) was comparable to the outcomes of studies from Western countries,35 while the PSM rate in patients with capsule invasion was as high as 49.5%. Therefore, the reason for the high PSM rate in this cohort was largely related to the high proportion of locally advanced disease.…”

Evaluation of the complications in transperitoneal laparoscopic renal and adrenal surgery with Clavien-Dindo classification

“…During first years of its application laparoscopic technique was mostly used for diagnostic purposes, and ablative procedures, however currently laparoscopic technique is being used successfully for oncological, and complex reconstructive procedures. [6][7][8] Because of more frequent use of laparoscopic surgery, we inevitably encounter complications related to this surgical technique more often. When literature data were reviewed, rates of complications related to laparoscopic interventions demonstrate a large distribution range.…”

Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

“…Unlike the proven benefit of ADT with EBRT in the management of high‐risk prostate cancer, the advantage of neoadjuvant or adjuvant ADT is controversial when high doses of RT are delivered to the prostate via brachytherapy . As a final point we must acknowledge that multi‐modality treatment is now gaining traction in men with high‐risk disease and has challenged the status of radiation in being the preferred treatment of such men . This typically involves surgery followed by radiation and/or systemic therapies.…”