Long‐term oncological and continence outcomes after laparoscopic radical prostatectomy: a single‐centre experience

Abstract

E 9 8 5What ' s known on the subject? and What does the study add? Over the past decade, minimally invasive laparoscopic radical prostatectomy and more recently robot-assisted laparoscopic prostatectomy have been introduced and have proven equally effective compared with open surgery in terms of mid-term cancer control and complication rates. Because long-term data is lacking, open prostatectomy is still considered the ' gold standard ' by some authors, who argue that minimally invasive approaches have to measure up to the excellent long-term results of open surgery.This study represents one of the largest series (1845 patients) of minimally invasive radical prostatectomy with extended follow-up (11.3 years) and detailed data on oncological outcome and postoperative incontinence. It therefore supplies previously lacking information on these details for minimally invasive prostate surgery and provides important information for patient counselling. OBJECTIVE• To investigate biochemical recurrence (BCR) rates and data on postoperative incontinence in a large laparoscopic radical prostatectomy (LRP) cohort with extended follow-up. MATERIALS AND METHODS• BCR and independent predictors of BCR were identifi ed using Kaplan -Meier and Cox regression analysis of 1845 patients who underwent LRP from 1999 to 2007.• Urinary incontinence was evaluated by pads per day and stratifi ed as follows: 0 -1 pad: no incontinence; 2 -3 pads: mild incontinence; and ≥ 3 pads: severe incontinence. RESULTS• Organ-confi ned disease, extraprostatic extension, seminal vesicle invasion and lymph node metastasis were present in 71.3%, 20.5%, 6.7% and 3.2% of patients, respectively. The positive surgical margin rate was 29.2%.• Postoperatively, 74.9% of the patients were continent, while 9.2% had mild and 15.9% severe incontinence.• The mean follow-up was 5 years with a maximum follow-up of 11.3 years.• There were 51 overall deaths and six deaths from prostate cancer. The 5-year, 8-year and 10-year BCR-free survival rates were 83.9%, 78.6% and 75.6%, respectively.• On univariate analyses preoperative D ' Amico risk classifi cation, pathological tumour stage, postoperative Gleason sum and surgical margin status were predictors of BCR ( P < 0.001).• On multivariable analysis, D ' Amico classifi cation, Gleason sum ( P < 0.001), postoperative tumour stage ( P < 0.001), nodal status ( P < 0.001) and surgical margin status ( P = 0.002) were independent predictors of BCR. CONCLUSIONS• LRP offers excellent long-term functional and oncological results with a low incidence of BCR for patients with localized disease.• These results could be used for patient counselling before robot-assisted laparascopic prostatectomy (RALP) until long-term follow-up data for RALP is available. KEYWORDSlaparoscopy , prostatectomy , localized prostate cancer , long-term outcome Study Type -Therapy (case series) Level of Evidence 4

Relationship of Positive Resection Margin, Cancer Location and Learning Curve after Laparoscopic Radical Prostatectomy

“…In our study, the 5-year PSA failure-free rate was 70.5%, and the prognostic factors for PSA failure were resection margin, EPE, and tumor diameter. The 5-year PSA failure-free survival for patients with a negative resection margin was 81.6%, and these results were similar to that in other reports [7][8][9][10]13].…”

“…Sooriakumaran et al reported that among 22,393 cases, the PRM of LRP was 16.3%, and that it was better than that of RRP, but was worse than that of RARP [14]. Other reports, including many LRP cases, concluded that the PRM varied from 7.4% to 29.2% [7][8][9][10]. Yossepowitch et al reported that a PRM increased the PSA failure rate 1.6-5.0-fold [15].…”

“…Since the long-term results of LRP have been reported, it is important to discuss the outcome with RARP [7][8][9][10]13]. Soares et al reported the results of LRP in 1,138 patients who were studied from 2000 through 2008 [10].…”

“…Many investigators reported prognostic factors for PSA failure, such as resection margin, PSA level, and pathological stage [7][8][9][10]. Among these prognostic factors, resection margin status was important because the PRM rate could be reduced by improvement of the surgical technique.…”

“…Recently, the long-term results of LRP were reported, including a study by Hruza et al on 370 patients [7][8][9][10]. According to this report, the 10-year cancer specific survival (CSS) rate was 100% in pT2 patients, 97.3% in pT3a patients, and 90.6% in pT3b/4 patients after a median observation period of 105 months.…”