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Minimum 5‐year follow‐up of 1138 consecutive laparoscopic radical prostatectomies
Author(s) -
Soares Ricardo,
Di Benedetto Antonina,
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.12887
Subject(s) - medicine , laparoscopic radical prostatectomy , neurovascular bundle , prostatectomy , surgery , body mass index , magnetic resonance imaging , complication , dissection (medical) , nuclear medicine , interquartile range , prostate cancer , urology , radiology , cancer
Objectives To investigate the long‐term outcomes of laparoscopic radical prostatectomy ( LRP ). Patients and Methods In all, 1138 patients underwent LRP during a 163‐month period from 2000 to 2008, of which 51.5%, 30.3% and 18.2% were categorised into D ' A mico risk groups of low‐, intermediate‐ and high‐risk, respectively. All intermediate‐ and high‐risk patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning, and had a pelvic lymph node dissection ( PLND ), which was extended after A pril 2008. The median (range) patient age was 62 (40–78) years; body mass index was 26 (19–44) kg/m 2 ; prostate‐specific antigen level was 7.0 (1–50) ng/mL and Gleason score was 6 (6–10). Neurovascular bundle was preservation carried out in 55.3% (bilateral 45.5%; unilateral 9.8%) of patients. Results The median (range) gland weight was 52 (14–214) g. The median (range) operating time was 177 (78–600) min and PLND was performed in 299 patients (26.3%), of which 54 (18.0%) were extended. The median (range) blood loss was 200 (10–1300) mL, postoperative hospital stay was 3 (2–14) nights and catheterisation time was 14 (1–35) days. The complication rate was 5.2%. The median (range) LN count was 12 (4–26), LN positivity was 0.8% and the median (range) LN involvement was 2 (1–2). There was margin positivity in 13.9% of patients and up‐grading in 29.3% and down‐grading in 5.3%. While 11.4% of patients had up‐staging from T1 /2 to T3 and 37.1% had down‐staging from T3 to T2 . One case (0.09%) was converted to open surgery and six patients were transfused (0.5%). At a mean (range) follow‐up of 88.6 (60–120) months, 85.4% of patients were free of biochemical recurrence, 93.8% were continent and 76.6% of previously potent non‐diabetic men aged <70 years were potent after bilateral nerve preservation. Conclusions The long‐term results obtainable from LRP match or exceed those previously published in large contemporary open and robot‐assisted surgical series.