[Open versus laparoscopic radical prostatectomy: a French center experience]. / Prostatectomie radicale ouverte versus laparoscopique: expérience d'un centre français.

OBJECTIVE: To compare peri-operative outcomes of open radical prostatectomy (ORP) to laparoscopic radical prostatectomy (LRP) in a single French institution. METHODS: Between 1998 and 2003, 72 patients underwent ORP followed by 279 LRP between 2003 and 2010 for a clinically localized prostate cancer. Demographic, peri-operative and pathological data in the ORP and LRP groups were analyzed and compared. RESULTS: In the ORP group, compared to the LRP group, the following significant differences were found: patients were older (63.1 years versus 65.6), initial PSA was higher (10.2 ng/mL versus 6.7) and the proportion of T1c was higher (62.8 % versus 80.6 %). Operative blood loss (1500 mL versus 500) and length of hospitalization (9.0 days versus 6.3) were higher in the ORP group (P<0.001). Operative time was longer in the LRP group (250 min versus 160; P<0 .001). There was no significant difference regarding length of catheterization (average of 8.5 days). Anastomotic strictures were more frequent following ORP (P<0.001). Positive margins proportion in the ORP group (7.1 %) was lower than that observed in the LRP group (28.7 %) (P=0.001). Patients in the ORP group achieved early continence more frequently (P<0.01) but at 12 months postoperatively there was no significant difference. CONCLUSION: Patients in the LRP group had lower operative blood losses and a shorter length of hospitalization. However, in the ORP group, operative time was shorter and positive margins rate was lower.

[Open partial nephrectomy: standard of minimal invasive surgery]. / Néphrectomie partielle par chirurgie conventionnelle : définir les critères de la chirurgie mini-invasive.

OBJECTIVE: Partial nephrectomy is now recognized as the standard treatment for tumors less than 7cm. The oncological results are comparable to those obtained by total nephrectomy, while preserving kidney function. Our objective was to describe our experience and research factors associated with complications, recurrence and death. PATIENTS AND METHODS: Partial nephrectomy performed in our center by June 1996 to December 2008 were reviewed retrospectively. Demographic and tumors characteristics, postoperative complications and patient outcomes were identified. Factors associated with complications and survival were investigated by regression tests. RESULTS: Of the 96 patients enrolled (mean age 61.4 years±12.8), 13 had renal insufficiency (serum creatinine 120 to 212µmol/L). The mean tumor size was 32mm (±13.9) and 57 (79.2%) corresponded to clear cell carcinoma. The overall rate of postoperative complications was 26%, including 8.3% of hemorrhagic complications and 3.1% of urinary complications. None of the analyzed variables were associated with the occurrence of complications. With a mean of 2 years and 9 months follow-up (±28months), eight patients (11.1%) had tumor recurrence. Multifocal tumors as well as postoperative complications were associated with risk of recurrence. Three patients with positive tumor margins were monitored with no evidence of progression (with 71, 42 and 12 months of follow-up). CONCLUSION: Our single-center retrospective study of partial nephrectomy for renal tumor showed medium-term oncological results similar to those reported in the total nephrectomy with the advantage of nephron preservation. The results of studies by conventional surgery such as that we report should be a benchmark for laparoscopic surgery.