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Laparoscopic radical prostatectomy for high‐risk prostate cancer
Author(s) -
Di Benedetto Antonina,
Soares Ricardo,
Dovey Zach,
Bott Simon,
McGregor Roy G.,
Eden Christopher G.
Publication year - 2015
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.12797
Subject(s) - medicine , neurovascular bundle , laparoscopic radical prostatectomy , prostatectomy , prostate cancer , urology , lymphadenectomy , biopsy , magnetic resonance imaging , body mass index , surgery , lymph node , nuclear medicine , cancer , radiology
Objective To investigate the results of performing laparoscopic radical prostatectomy ( LRP ) in patients with high‐risk prostate cancer ( HRPC ): PSA level of ≥20 ng/mL ± biopsy Gleason ≥8 ± clinical T stage ≥2c. Patients and Methods Of a total of 1975 patients having LRP during a 159‐month period from 2000 to 2013, 446 (22.6%) had HRPC ; all patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning. The median (range) patient age was 64.0 (36–79) years; body mass index 27.0 (18–43) kg/m 2 ; PSA level 8.1 (0.1–93) ng/mL and biopsy G leason 8 (6–10). All patients had a pelvic lymphadenectomy, which was done using an extended template after A pril 2008 (53.3%). Neurovascular bundle ( NVB ) preservation was done in 41.5% (bilateral 26.3%; unilateral 15.2%) of patients; an incremental or partial nerve‐sparing technique was used in 99 of the 302 (32.8%) NVBs preserved. Results The median (range) gland weight was 58.5 (20–161) g; operating time 180 (92–330) min; blood loss 200 (10–1400) mL; postoperative hospitalisation 3.0 (2–7) nights; catheterisation time 14 (2–35) days; complication rate 7.6%; lymph node ( LN ) count 16 (2–51); LN positivity 16.2%; LN involvement 2 (1–8); positive surgical margin ( PSM ) rate 26.0%; up‐grading 2.5%; down‐grading 4.3%; up‐staging from T1/2 to T3, 24.7%; down‐staging from T3 to T1/2, 6.1%. No cases were converted to open surgery and three patients were transfused (0.7%) after surgery. At a mean (range) follow‐up of 24.9 (3–120) months, 79.2% of patients were free of biochemical recurrence, 91.8% were continent and 64.4% of previously potent non‐diabetic men aged <70 years were potent after bilateral nerve preservation. Conclusion The low morbidity, 55.4% specimen‐confinement rate, 26.0% PSM rate, 79.2% biochemical disease‐free survival, 91.8% continence rate and 64.4% potency rate, at 35.2 months in the present study serve as evidence firstly that surgery is an effective treatment for patients with HRPC , curing many and representing the first step of multi‐modal treatment for others, and that LRP for HRPC appears to be as effective as open RP in this context.