Perioperative outcomes of open radical prostatectomy versus laparoscopic radical prostatectomy in Asian men: comparison of two initial series by the same surgeon

PURPOSE: To compare the perioperative outcomes in 2 initial series of open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) in Asian men with prostate cancer. MATERIAL AND METHODS: From March 1999 to February 2007, the first 100 consecutive patients who underwent ORP and the first 100 consecutive patients who underwent LRP by the same surgeon (SL) were assessed. Mean age, clinical stage, preoperative PSA level, Gleason score, operative time, estimated blood loss, blood transfusion rate, perioperative complications, pathological stage and margin status were compared between the 2 groups. RESULTS: For each 100 patients in ORP and LRP, mean age and clinical stage were not significantly different. The operative time in LRP was significantly longer than ORP (188 ± 55 versus 114 ± 31 minute, p value = 0.01). Mean estimated blood loss and blood transfusion rate in LRP was significantly lower than ORP, 521 ± 328 versus 809 ± 510 mL (p value = 0.03) and 27 percent versus 55 percent (p value = 0.01), respectively. For pathological organ confined disease, the free surgical margin rate of ORP and LRP was not significantly different (88.9 percent versus 91.3 percent, respectively, p = 0.58). There was no significant major complication in either group. CONCLUSIONS: For initial experience by a single surgeon, LRP is comparable to ORP with no significant morbidity. LRP had longer operative time. However, LRP decreased blood loss and blood transfusion. For localized prostate cancer, free surgical margin rate of ORP and LRP was not significantly different.

Histologic types, staging, resectability, and smoking among Thai patients with lung cancer.

AIM: To examine the prevalence of cigarette smoking, histological types, staging at presentation and resectability among Thai patients with lung cancer. SETTING: A 500-bed referral cardiothoracic centre. METHOD: Prospective study with pre-defined outcome data, from January to December 1996. RESULTS: A total of 349 patients were histologically proved to have lung cancer. The mean age was 60 years (SD 12.5). There were 264 males and 85 females. 269 patients (77%) were smokers. Percentage of histopathologic types were 39 per cent adenocarcinoma, 30 per cent squamous cell carcinoma, 20 per cent undifferentiated cell carcinoma, and 11 per cent small cell carcinoma. The association with smoking is stronger in squamous cell carcinoma and small cell carcinoma and weaker in adenocarcinoma. Most patients (82%) were in advanced stages, stage 3B and 4.18 per cent of the patients were in stages eligible for surgery, i.e. stage 1, 2 and 3A. However, only 9.7 per cent of the patients were operable and 9.1 per cent were resectable. CONCLUSIONS: On reaching the diagnosis, most patients with lung cancer were in advanced stages of the disease, rendering a low resectability. The results emphasise the need for early diagnostic intervention in patients presenting with lung mass. Furthermore, preventive measures including a campaign against cigarette smoking, research into other possible aetiological factors should be more encouraged.

The anatomic distribution of colorectal cancer in a New York City Puerto Rican group

Studies have attempted to define the anatomic distribution of colorectal cancer in some black and white groups of the U.S. However, little, if any research has looked at the regional distribution of colorectal cancer in an American Hispanic, especially Puerto Rican, group. This study attempts to provide some insight into the subsegmental distribution of colorectal cancer in this group of the American population which has a heavy concentration of people in many major U.S. cities. We retrospectively reviewed the charts of Puerto Rican patients who had colorectal adenocarcinoma and were on the files of the tumor registries of two principal teaching hospitals of a New York City medical school from 1976-95, and collected the age and location of the cancers. Patients were self identified as being of Puerto Rican descent. Right colon cancers were from the cecum up to the hepatic flexure, left from the splenic flexure down to the sigmoid colon, rectal which included rectosigmoid, transverse and cancers of unknown locations. The latter were not included in the anatomic analysis since the location was not known. There were eleven of these patients. The anatomic analysis was of 134 patients. There were 67 women, and 78 men with a mean age of 60.3 years, and 63.7 years respectively with an overall mean age of 62.2 years. The anatomic distribution of the cancers were as follows: right colon cancer represented 22.4 or 30/134, transverse lesions equaled 1.5 or 2/134, left cancers were found in 38.0 or 51/134, rectal malignancies equaled 38.0 or 51/134. Previously, it has been shown that the presentation of right sided colorectal cancer in white and black Americans is greater than the 22.4 seen in the Puerto Rican group of this study. However, these previous groups have been found to have 50 of cancers located distal to the splenic flexure, similar to the Puerto Ricans in this study. The average age of Puerto Ricans presenting with colorectal cancer compared to the average age of the general population may be different. Screening techniques for colorectal cancer may be adequate for detecting colorectal cancer in Puerto Ricans, however if they are indeed presenting at a relatively early age, the techniques may need to be applied earlier in comparison to the general American population. Further study is needed to see if the age of presentation is indeed as early as suggested by the present study