Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Over the past decade, minimally invasive laparoscopic radical prostatectomy and more recently robot-assisted laparoscopic prostatectomy have been introduced and have proven equally effective compared with open surgery in terms of mid-term cancer control and complication rates. Because long-term data is lacking, open prostatectomy is still considered the ‘gold standard’ by some authors, who argue that minimally invasive approaches have to measure up to the excellent long-term results of open surgery.
This study represents one of the largest series (1845 patients) of minimally invasive radical prostatectomy with extended follow-up (11.3 years) and detailed data on oncological outcome and postoperative incontinence. It therefore supplies previously lacking information on these details for minimally invasive prostate surgery and provides important information for patient counselling.
- • To investigate biochemical recurrence (BCR) rates and data on postoperative incontinence in a large laparoscopic radical prostatectomy (LRP) cohort with extended follow-up.
MATERIALS AND METHODS
- • BCR and independent predictors of BCR were identified using Kaplan–Meier and Cox regression analysis of 1845 patients who underwent LRP from 1999 to 2007.
- • Urinary incontinence was evaluated by pads per day and stratified as follows: 0–1 pad: no incontinence; 2–3 pads: mild incontinence; and ≥3 pads: severe incontinence.
- • Organ-confined disease, extraprostatic extension, seminal vesicle invasion and lymph node metastasis were present in 71.3%, 20.5%, 6.7% and 3.2% of patients, respectively. The positive surgical margin rate was 29.2%.
- • Postoperatively, 74.9% of the patients were continent, while 9.2% had mild and 15.9% severe incontinence.
- • The mean follow-up was 5 years with a maximum follow-up of 11.3 years.
- • There were 51 overall deaths and six deaths from prostate cancer. The 5-year, 8-year and 10-year BCR-free survival rates were 83.9%, 78.6% and 75.6%, respectively.
- • On univariate analyses preoperative D'Amico risk classification, pathological tumour stage, postoperative Gleason sum and surgical margin status were predictors of BCR (P < 0.001).
- • On multivariable analysis, D'Amico classification, Gleason sum (P < 0.001), postoperative tumour stage (P < 0.001), nodal status (P < 0.001) and surgical margin status (P= 0.002) were independent predictors of BCR.
- • LRP offers excellent long-term functional and oncological results with a low incidence of BCR for patients with localized disease.
- • These results could be used for patient counselling before robot-assisted laparascopic prostatectomy (RALP) until long-term follow-up data for RALP is available.