Oncology Prostate Cancer
Table 1: Peri-operative Outcomes in the Literature Series
Number of Approach Patients
Joseph et al., 200610 Rozet et al., 200711
Ploussard et al., 201012 Badani et al., 200713
325 133 206
2,766
Extraperitoneal 180 Extraperitoneal 166 Extraperitoneal 160.1 Transperitoneal 154
Table 2: Oncological Outcomes in the Literature Series
Number of Approach Patients
Joseph et al., 200610 Rozet et al., 200711
Ploussard et al., 201012 Badani et al., 200713
325 133 206
2,766
Extraperitoneal Extraperitoneal Extraperitoneal Transperitoneal
Table 3: Functional Outcomes in the Literature Series
Joseph et al., 200610 Madeb et al., 200716 Ploussard et al., 201012 Xylinas et al., 201017
Number of Patients 325 150 206 50
Approach
Extraperitoneal Extraperitoneal Extraperitoneal Extraperitoneal intrafascial
improvement, with its growth being exponential in recent years. Almost a decade after the introduction of RALP, large and mature series from different institutions are now available.
This article reviews the development and introduction of extraperitoneal RALP, the results to date and possible future directions. The aim of this study is to underline the peri-operative, oncological and functional outcomes of all extraperitoneal RALP series published.
Peri-operative Outcomes and Complications The mean operative duration, body mass index (BMI), clinical stage, estimated blood loss, blood transfusion rates, hospital stay and overall complication rates for current extraperitoneal RALP series are presented in Table 1.10–13
It is difficult to compare operative
duration among various series because of variations in reporting this variable to include set-up and/or pelvic lymph-node dissection. The mean operative duration for current extraperitoneal RALP series is 160–180 minutes.10–12
Decreased intraoperative blood loss has been reported to be a hallmark advantage of LRP.5–8
As most intraoperative blood loss
originates from the venous sinuses, the tamponade effect created by pneumoperitoneum helps to diminish blood loss. In addition, early identification and precise ligation of vessels facilitates the limitation of blood loss. The estimated blood loss for RALP series included in this review ranged from 196 to 609ml. The blood transfusion rate varied from 0.5 to 3%.10–12
Mean hospital stay is an important component of convalescence after surgery and is often considered to be a measure of patient wellbeing. The mean hospital stay for current RALP series was from 1.5 to 5.4 days. The hospital stay for RALP series carried out in the US is usually lower than in series from Europe, where patients often stay in the
16
Previous studies showed that surgeon experience and learning curve could affect and predict oncological outcomes after RALP. Patel et al.,15
evaluating 500 consecutive RALPs performed by one surgeon, reported a PSM rate of 13% in the first 100 patients and 8% in the last 100 of the series.
Functional Outcomes
Compilation of data for urinary continence from different RP series is difficult due to variations in definitions, data collection methods and length of follow-up. In this review, the definition of continence adopted, when more than one definition was available in the study, was the use of no absorbent pads. Reports for RALP showed continence rates up to 78% at three months and up to 98% at 12 months of follow-up, respectively (see Table 3).10,12,16,17
Several
technical modifications were proposed to promote an earlier return of continence after RP, with variable results.18–23
Potency is one of the most difficult outcomes to compare after RP. Factors other than the surgeon or the approach have a significant
EUROPEAN UROLOGICAL REVIEW
Operative
Complication
Time (Minutes) Rate (%) 2
19.4 16.5 12
Blood Loss (ml)
196 609 504 100
Conversion Rate (%)
– 13
0.5 –
Hospital
Stay (Days) –
5.4 4.3 1.2
pT2 81
Pathological Stage (%) pT3
19
88.5 65
77.7
11.5 28 22
pT4 0 0 7
0.3
pT2 -
13
17.2 12.3
Positive Surgical Margins (%) pT3
-
20.9 -
35
19.5 27.7 13
Overall 13
Follow-up (Months) Continence (%) 6 6
96 –
12 3
98 78
Potency (%) 47 45 39 60
hospital until the urinary catheter is removed. The mean overall complication rate for RALP series was 10.5% (range 2–19.4%).10–12
Oncological Outcomes
The positive surgical margin (PSM) rate after RP is an independent predictive factor for biochemical recurrence, local recurrence and the development of distant metastasis.14
Therefore, the status of the
surgical margin is one of the most important outcomes to evaluate in any surgical treatment proposed for prostate cancer. The pathological stage distribution in the RALP series included in this review was 78% for pT2 and 19.5% for pT3 tumours. RALP had a mean overall PSM rate of 20% (range of means 13–27.7%). The ranges of means for PSM were from 12.3 to 17.2%, and from 20.9 to 35% in pT2 and pT3 tumours, respectively (see Table 2).10–12
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