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Five‐year oncological outcomes of endoscopic extraperitoneal radical prostatectomy ( EERPE ) for prostate cancer: results from a medium‐volume UK centre
Author(s) -
McNeill S. Alan,
Good Daniel W.,
Stewart Grant D.,
Stolzenburg JensUwe
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12260
Subject(s) - medicine , interquartile range , prostate cancer , biochemical recurrence , prostatectomy , urology , surgical margin , stage (stratigraphy) , prostate specific antigen , cancer , demographics , laparoscopic radical prostatectomy , surgery , paleontology , biology , demography , sociology
Objective To determine the 5‐year oncological outcomes of endoscopic extraperitoneal radical prostatectomy ( EERPE ) from a medium‐volume centre, thereby providing much needed data on outcomes from the UK .Patients and Methods From J anuary 2006 to J anuary 2012, 575 patients underwent EERPE for localized prostate cancer, performed by a single surgeon who had completed a modular training programme. Follow‐up was as per local hospital policy and data were collected in our prospective database. A retrospective review of patient demographics, prostate‐specific antigen ( PSA ) levels, pathological T stages, G leason scores, surgical margin status and biochemical recurrence ( BCR ) data was performed. BCR was defined as PSA >0.2 μg/L.Results The mean (range) patient age was 62 (40.3–76.5) years and the mean (range) follow‐up was 30 (12–72) months. The median (interquartile range [ IQR ]) operating time was 135 (120–170) min and the median ( IQR ) blood loss was 200 (100–250) mL. Of the 575 patients, 135 (23.5%) had positive surgical margins ( PSMs ). The PSM rate for pT2 disease was 66/406 patients (16.3%) and for pT3 disease it was 68/168 patients (40.5%). Overall BCR ‐free survival at 5‐years was 81.5%. Multivariate C ox analysis showed that PSMs , G leason score, D ' A mico risk category and pT stage were independent predictors of BCR ‐free survival.Conclusions This assessment of the oncological results of EERPE , which included the surgical learning curve, shows that the adoption of EERPE after mentored fellowship training translates into mid‐term oncological outcomes in line with those of retropubic/transperitoneal laparoscopic approaches and with large‐volume centres worldwide which have pioneered laparoscopic radical prostatectomy. The study shows that EERPE in a medium‐volume second generation laparoscopic centre (that introduced EERPE after adequate training in pioneering centres) produces results with good 5‐year oncological outcomes, similar to those of other major series, for patients in the UK .