https://doi.org/10.4081/aiua.2021.3.268

Oncological and functional outcomes of extraperitoneal laparoscopic radical prostatectomy: An 18-years, single-center experience

Vol. 93 No. 3 (2021)
Submitted: May 27, 2021
Accepted: June 27, 2021
Published: September 30, 2021
Prostate cancer, Radical prostatectomy, Laparoscopic prostatectomy, Laparoscopy, Extraperitoneal prostatectomy
Abstract Views: 1097
PDF: 484
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Francesco Saverio Grossi
grossifs@libero.it
https://orcid.org/0000-0003-2985-6526
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Emanuele Utano
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Paolo Minafra
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Pier Paolo Prontera
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Francesco Schiralli
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Antonio De Cillis
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Evangelista Martinelli
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Marco Lattarulo
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Meri Luka
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Antonio Carrieri
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.
Angelo D’Elia
Urology Unit, S.S. Annunziata Hospital, Taranto, Italy.

Objective: To present a retrospective analysis on the oncological and functional outcomes of a single-center experience on a large series of extraperitoneal laparoscopic radical prostatectomies (eLRP) with an extended follow-up.
Materials and methods: Herein we present a retrospective review of patients who underwent eLRP. Oncological and functional follow-up data were collected by means of outpatient visits and telephone interviews, assessing overall mortality and biochemical recurrence-free survival. Patients with clinical T4 stage prostate cancer (PCa), previous surgery for benign prostatic hyperplasia (BPH), previous androgen deprivation, radiotherapy, concomitant chemotherapy and/or experimental therapies, and with insufficient follow-up data were excluded. Preoperative data recorded were age, body mass index, ultrasound prostate volume, preoperative PSA and clinical stage of PCa. Operative data (operative time, nerve sparing technique and any perioperative complication) and pathological findings were obtained by consulting the surgical and pathological reports. Oncological and functional follow-up were collected during follow-up visits and telephone interview.
Results: Between January 2001 and December 2019, overall 938 eLRP were performed at our Institution. The median follow-up was 132 months. 69.7% of the patients had complete dataset. The estimated overall biochemical recurrence (BCR)-free survival was 71.4% at 5 years and 58.9% at 10 years. Cancer specific survival was 84,5%. Erectile function was preserved in the most of patients as postoperative IIEF-5 score within 12 months after surgery was > 12 in the 82.1%. About the urinary incontinence, 0.76% of the patients presented severe incontinence (continued and persistent loss of urine) and 7.0% were mildly incontinent (using up to one pad per day).
Conclusions; eLRP has shown oncological and functional results comparable to other minimally invasive techniques and to open radical prostatectomy (ORP), with favorable perioperative outcomes than the open technique and a reduced complication rate.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020; 70(1):7-30. DOI: https://doi.org/10.3322/caac.21590
https://uroweb.org/wp-content/uploads/EAU-EANM-ESTROESUR-ISUP-SIOG-Guidelines-on-Prostate-Cancer-2021V4.pdf
Ilic D, Evans SM, Allan CA, et al. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev. 2017; 9:CD009625. DOI: https://doi.org/10.1002/14651858.CD009625.pub2
Sujenthiran A, Nossiter J, Parry M, et al. National cohort study comparing severe medium-term urinary complications after robotassisted vs laparoscopic vs retropubic open radical prostatectomy. BJU Int. 2018;121:445-52. DOI: https://doi.org/10.1111/bju.14054
Hyldgård VB, Laursen KR, Poulsen J, Søgaard R. Robot-assisted surgery in a broader healthcare perspective: a difference-in-difference-based cost analysis of a national prostatectomy cohort. BMJ Open. 2017; 7:e015580. DOI: https://doi.org/10.1136/bmjopen-2016-015580
Bollens R, Vanden Bossche M, Roumeguere T, et al. Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol. 2001; 40:65-9. DOI: https://doi.org/10.1159/000049750
Raboy A, Ferzli G, Albert P. Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology. 1997;50:849-53. DOI: https://doi.org/10.1016/S0090-4295(97)00485-8
Boccon-Gibod L, Djavan W, Hammerer P, et al. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. Int J Clin Pract. 2004; 58:382-90. DOI: https://doi.org/10.1111/j.1368-5031.2004.00184.x
Toussi A, Stewart-Merrill S, Boorjian S, et al. Standardizing the definition of biochemical recurrence after radical prostatectomy. What prostate specific antigen cut point best predicts a durable increase and subsequent systemic progression? J Urol. 2016;195:1754-9. DOI: https://doi.org/10.1016/j.juro.2015.12.075
Rhoden E, Telöken C, Sogari P, Vargas Souto C. The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int J Impot Res. 2002; 14:245-50. DOI: https://doi.org/10.1038/sj.ijir.3900859
Grossi FS, Di Lena S, Barnaba D, et al. Laparoscopic versus open radical retropubic prostatectomy: a case-control study at a single institution. Arch Ital Urol Androl. 2010; 82:109-12.
Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997; 50:854-7. DOI: https://doi.org/10.1016/S0090-4295(97)00543-8
Türk I, Deger S, Winkelmann B, et al. Laparoscopic radical prostatectomy. Technical aspects and experience with 125 cases. Eur Urol. 2001;40:46-52. DOI: https://doi.org/10.1159/000049748
Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol. 2000;163:1643-9. DOI: https://doi.org/10.1016/S0022-5347(05)67512-X
van Velthoven RFP. Laparoscopic radical prostatectomy: transperitoneal versus retroperitoneal approach: is there an advantage for the patient?. Curr Opin Urol. 2005; 15: 83-8. DOI: https://doi.org/10.1097/01.mou.0000160621.05742.a4
Porpiglia F, Terrone C, Tarabuzzi R, et al. Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy: experience of a single center. Urology. 2006; 68:376-80. DOI: https://doi.org/10.1016/j.urology.2006.02.039
Eden C, King D, Kooiman G,, et al. Transperitoneal or extraperitoneal laparoscopic radical prostatectomy: does the approach matter? J Urol. 2004; 172:2218-23. DOI: https://doi.org/10.1097/01.ju.0000144640.26182.41
Stolzenburg J, Truss M, Bekos A, et al. Does the extraperitoneal laparoscopic approach improve the outcome of radical prostatectomy? Curr Urol Rep. 2004; 5:115-22. DOI: https://doi.org/10.1007/s11934-004-0023-9
Stolzenburg J, Rabenalt R, Do M, et al. Laparoscopic extraperitoneal radical prostatectomy: changes in time and updated results. Actas Urol Esp. 2006; 30:556-66. DOI: https://doi.org/10.1016/S0210-4806(06)73495-7
Magheli A, Busch J, Leva N, et al. Comparison of surgical technique (open vs. laparoscopic) on pathological and long term functional outcomes following radical prostatectomy. BMC Urol. 2014.7;14:18. DOI: https://doi.org/10.1186/1471-2490-14-18
Dahl D, Barry M, McGovern F, et al. A prospective study of symptom distress and return to baseline function after open versus laparoscopic radical prostatectomy. J Urol. 2009; 182:956-65. DOI: https://doi.org/10.1016/j.juro.2009.05.044
Jurczok A, Zacharias M, Wagner S, et al. Prospective non-randomized evaluation of four mediators of the systemic response after extraperitoneal laparoscopic and open retropubic radical prostatectomy. BJU Int. 2007;99:1461-6. DOI: https://doi.org/10.1111/j.1464-410X.2007.06849.x
Jacobsen N, Moore K, Estey E, Voaklander D. Open versus laparoscopic radical prostatectomy: a prospective comparison of postoperative urinary incontinence rates. J Urol. 2007; 177:615-9. DOI: https://doi.org/10.1016/j.juro.2006.09.022
Paul A, Ploussard G, Nicolaiew N, et al. Oncologic outcome after extraperitoneal laparoscopic radical prostatectomy: midterm followup of 1115 procedures. Eur Urol. 2010; 57:267-72. DOI: https://doi.org/10.1016/j.eururo.2009.09.029
Wang K, Zhuang Q, Xu R, et al. Transperitoneal versus extraperitoneal approach in laparoscopic radical prostatectomy: A meta-analysis. Medicine (Baltimore). 2018; 97:e11176. DOI: https://doi.org/10.1097/MD.0000000000011176
Kallidonis, Panagiotis P, Rai, Bhavan PB, et al. Critical appraisal of literature comparing minimally invasive extraperitoneal and transperitoneal radical prostatectomy: A systematic review and meta-analysis. Arab J Urol. 2017; 15:267-279. DOI: https://doi.org/10.1016/j.aju.2017.07.003
Cao L, Yang Z, Qi L, Chen C. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine (Baltimore). 2019; 98:e15770. DOI: https://doi.org/10.1097/MD.0000000000015770
Uchio E, Aslan M, Wells C, et al. Impact of biochemical recurrence in prostate cancer among US veterans. Arch Intern Med. 2010;170:1390-5. DOI: https://doi.org/10.1001/archinternmed.2010.262
Chun F, Graefen M, Zacharias M, et al. Anatomic radical retropubic prostatectomy-long-term recurrence-free survival rates for localized prostate cancer World J Urol. 2006; 24:273-80. DOI: https://doi.org/10.1007/s00345-006-0058-2
Hruza M, Bermejo J, Flinspach B, et al. Long-term oncological outcomes after laparoscopic radical prostatectomy. BJU Int. 2013;111:271-80. DOI: https://doi.org/10.1111/j.1464-410X.2012.11317.x
Busch J, Stephan C, Herold A, et al. Long-term oncological and continence outcomes after laparoscopic radical prostatectomy: a single-centre experience BJU Int. 2012; 110:E985-90. DOI: https://doi.org/10.1111/j.1464-410X.2012.11279.x
Martínez-Holguín E, Herranz-Amo F, Mayor de Castro J, et al. Comparison between laparoscopic and open prostatectomy: Oncological progression analysis. Actas Urol Esp. 2021; 45:139-145. DOI: https://doi.org/10.1016/j.acuroe.2020.09.006
Walsh. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol. 2000; 163:1802-7. DOI: https://doi.org/10.1016/S0022-5347(05)67547-7
Abboudi H, Doyle P, Winkler M. Day case laparoscopic radical prostatectomy. Arch Ital Urol Androl. 2017;89:182-185. DOI: https://doi.org/10.4081/aiua.2017.3.182
Gozen AS, Akin Y, Ates M, et al. The impact of bladder neck sparing on urinary continence during laparoscopic radical prostatectomy; Results from a high volume centre. Arch Ital Urol Androl 2017; 89:186-191. DOI: https://doi.org/10.4081/aiua.2017.3.186

How to Cite

grossi, francesco saverio, Utano, E., Minafra, P., Prontera, P. P. ., Schiralli, F. ., De Cillis, A. ., Martinelli, E. ., Lattarulo, M. ., Luka, M. ., Carrieri, A. ., & D’Elia, A. . (2021). Oncological and functional outcomes of extraperitoneal laparoscopic radical prostatectomy: An 18-years, single-center experience. Archivio Italiano Di Urologia E Andrologia, 93(3), 268–273. https://doi.org/10.4081/aiua.2021.3.268

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.