Laparoscopic Radical Prostatectomy: The Lessons Learned

Abstract

Purpose:

To evaluate the operative, oncologic, and functional results of laparoscopic radical prostatectomy based on an initial series of 350 patients.

Patients and Methods:

Between January 1998 and May 2000, 350 consecutive patients underwent laparoscopic radical prostatectomy according to our technique. The study of operative morbidity was based on all intraoperative and postoperative complications. The oncologic assessment was based on clinical, laboratory, and intraoperative and postoperative pathological data. Postoperative functional results were assessed by the ICS-male self-administered questionnaire.

Results:

No deaths were observed in this series. Conversion was required in seven cases, exclusively among the first 70 patients. The mean operating time was 217 ± 59 minutes, including the lymphadenectomy phase that was considered necessary in 21.4% of patients, and 195 ± 56 minutes for the most recent 200 patients. The mean intraoperative blood loss was 354 ± 250 mL. The overall transfusion rate was 5.7% and 2.8% in the last 250 patients. Intraoperative complications were reported in 14 patients (4%), and the reoperation rate was 3.7%. The mean postoperative bladder catheterization time was 5.8 ± 3.3 days, and the catheter could be removed before the 5th day in 41% of patients. The mean hospital stay was 6 ± 3.9 postoperative days (range 2-33 days). By pathologic stage, the positive surgical margin rate was 3.6% for pT_2a specimens (3 patients), 14% for pT_2b specimens (29 patients), 33% for pT_3a specimens (12 patients), and 43.5% for pT_3b specimens (10 patients). In the first 75 patients with pT₂N₀/N_x negative-margin specimens and a follow-up of >12 months, the PSA concentrations was <0.2 ng/mL in 92% of patients. The continence rate (no protection necessary either during the day or at night) among the first 133 patients was 85.5% and the postoperative erection rate was 59% among 22 selected consecutive patients.

Conclusions:

This study confirms the value, in our experience, of the laparoscopic approach to radical prostatectomy, which allows satisfactory cancer control associated with low perioperative morbidity and encouraging functional results in terms both of continence and erectile function.