Liatsikos_edit.qxp 1/8/07 10:01 Page 35
The Challenge of Extraperitoneal Endoscopic Radical Prostatectomy
Table 4: Complications in 1,300 Extraperitoneal Endoscopic Radical Prostatectomies
Clavien Grade n (%) Management
Intra-operative complications
I Rectal injury 6 (0.5%) Two-layer suture
IIIa Injury to interureteric crest 1 (0.1%) DJ catheter placement and suture
Early complications (<1 month post-operatively)
I’d’ Anastomotic leakage 24 (1.8%) Prolonged catheterisation (>14 days)
II Pre-peritoneal haematoma 2 (0.1%) Conservative
II Deep-vein thrombosis 6 (0.5%) Conservative
II Urinary tract infection 8 (0.6%) Conservative (antibiotics)
II’d’ Temporary obturator nerve apraxia 2 (0.2%) Conservative
II’d’ Pubic osteitis 1 (0.1%) Antibiotic treatment
IIIa Perineal haematoma 2 (0.2%) Percutaneous drainage
IIIa IIIa Anuria 2 (0.2%) DJ catheter placement (1 )
Nephrostromy placement (1)
IIIa IIIb Symptomatic lymphocele 23 (3.8%)* Percutaneous puncture (6)
(608xPLA) Laparoscopic fenestration (11)
IIIa IIIb Anastomotic leakage 7 (0.5%) Mono J catheter placement (6 )
Re-anastomosis (2 days post-operatively) (1)
IIIb Recto-urethral fistula 2 (0.1%) Colostomy, secondary repair
IIIb IIIb Bleeding/haematoma 11(1.08%) Endoscopic revision (5)
Open revision (6)
IVa Urosepsis 1 (0.1%) Conservative (intensive care for five days)
Late complications (>1 month post-operatively)
IIIa Anastomotic stricture 2 (0.2%) Endoscopic bladder neck incision
IIIb Port-site hernia 2 (0.2%) Open repair
were 72 and 81%, respectively.
2
It should be noted that the return of Intrafascial nsEERPE is surely a very promising refinement of our
sexual function after unilateral and bilateral nerve-sparing radical technique. Three months post-operatively, 73.7% of the patients were
prostatectomy may require 48 months. Consequently, the short-term continent, 21.1% required one to two pads per day and 5.2% required
potency rates should be discussed with care.
21
more than two pads per day. After six months of follow-up, the above
figures were 84.7, 14.1 and 1.2%, respectively. Potency rates six
Although long-term oncological results are not yet available, cancer control months post-operatively for unilateral and bilateral intrafascial nsEERPE
outcome of EERPE seems similar to those of conventional or laparoscopic were 20 and 60%, respectively. After 12 months of follow-up, these
procedures. Positive surgical margin after open radical prostatectomy in the were 33.3 and 79.1%, respectively. The above data represent the better
Wieder and Soloway series has been reported to be present in 28% of early continence and potency results of intrafascial nsEERPE compared
cases.
24
In our centre, positive surgical margin rates were 9.8% (83/845) for with EERPE and nsEERPE. Complications occurred in 4% of the cases.
patients with a pT2-tumour (pT2a=2.1%, pT2b=18.9%, pT2c=10.5%), Post-operative positive surgical margin rates were present in 6.1% for
and 34.3% (154/448) for patients with a pT3-tumour (pT3a=30.6%, pT2 and 20% for pT3 tumours. It should be noted that all the intrafascial
pT3b=43.8%). The histological results of 1,000 LRPs at Montsouris Institute nsEERPE procedures were performed by the same surgeon.
were positive in 6.9% for pT2a and 34% for pT3b tumours.
4
In conclusion, the results of EERPE are promising and similar to any of the
A relatively low number of patients have undergone nsEERPE in our existing prostatectomy techniques. The combination of the advantages of
series due to the selection indications. Post-operative pathological stages minimally invasive surgery (low morbidity) and RRP (oncological results)
in the population of 1,300 patients were pT3a in 320 patients (24.7%) with the totally extraperitoneal (low complications) approach is present in
and pT3b in 128 (9.8%). However, most of the published series of EERPE and nsEERPE. A large number of cases document the feasibility and
radical prostatectomy report the rate of patients with pT3 tumour to be efficiency of the procedure well. The most recent intrafascial nsEERPE
under 25%.
4,25
This is possibly due to the employment of individual further improves the results of EERPE. ■
patterns of patient selection and PSA screening policies. However, this
relatively high rate of pT3 surgical pathology seems to have no impact A version of this article with an additional table can be found in the
on our functional results. Indeed, they are equal to those published for reference section on the website supporting this briefing
open prostatectomy and LRP.
18,20,26
(www.touchbriefings.com).
1. Rassweiler J, et al., Curr Opinion in Urol, 2004,14:75. 10. Stolzenburg JU, et al., World J Urol, 2002;20:48. 19. Walsh PC, J Urol, 2000;163:1802.
2. Anastasiadis AG, et al., Urology, 2003;62:292. 11. Stolzenburg JU, Truss MC, BJU International, 2003;91:749. 20. Kundu SD, et al., J Urol, 2004;172:2227.
3. Brown JA, et al., Urology, 2003;62:481. 12. Stolzenburg JU, et al., World J Urol, 2003;21:147. 21. Rabbani F, et al., J Urol, 2004;171(Suppl. 4):A1178.
4. Guillonneau B, et al., J Urol, 2003;169:126. 13. Stolzenburg JU, et al., J Urol, 2005;174:1271–5. 22. Guillonneau B, et al., Urol Clin North Am, 2001;28:189.
5. Steinberg AP, Gill IS, Cleve Clin J Med, 2004;71:78. 14. Stolzenburg JU, et al., Europ Urology, 2006;49:103–12. 23. Türk I, et al., Urologe A, 2001;40:199.
6. Rassweiler J, et al., J Urol, 2003;169:1689. 15. Stolzenburg JU, et al., J Endourol, 2006;20:925–9. 24. Wieder JA, Soloway MS, J Urol, 1998;160:299.
7. Stolzenburg JU, et al., J Urol, 2003;169:2066. 16. Stolzenburg JU, et al., Urology, 2006;67:17–21. 25. Eastham JA, Scardino PT. In: Walsh PC, et al. (eds), Campbell´s
8. Vallancien G, et al., J Urol, 2002;168:23. 17. Vallancien G, et al., J Urol, 2002;168:23. Urology, 8th edn, volume 4, Saunders, 2002;3080–3106.
9. Guillonneau B, et al., J Urol, 2002;167:51. 18. Noldus J, et al., Eur Urol, 2002;42:118. 26. Guillonneau B, et al., Urol Clin North Am, 2001;28:189.
EUROPEAN GENITO-URINARY DISEASE 2007 35
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