RESUMO
OBJECTIVE: To determine the predicting factor of biochemical recurrence and analysis of pathological and oncological outcomes following laparoscopic radical prostatectomy (LRP) at Rajavithi Hospital in Thailand. MATERIAL AND METHOD: One hundred twenty men underwent laparoscopic radical prostatectomy between October 2006 and December 2011. Four men were excluded due to open surgical conversions and fourteen men were excluded due to lacking of follow-up. The remaining 102 men had a mean preoperative prostate specific antigen of 21.4 ng/ml (ranging from 0.4 to 185) and Gleason score of 6.2 (ranging from 6 to 10). Stage was cT1b in one case (1%), cT1c in 66 (64.7%), cT2 in 28 (27. 5%), and cT3 in seven (6.9%). Immediate postoperative adjuvant therapy of twenty-six men was excluded from biochemical recurrence analysis. RESULTS: Mean follow-up period was 19.7 months (median 16, ranging from 2 to 54.8). Pathological stage was pT0N0 in two men (2%), pT2N0 in 78 (76.5%), pT3N0 in 11 (10.8%), and pT2-3N1 in 11 (10.8%). Positive surgical margin (SM) rates increased with higher stage (23.1% in pT2, 63.6% in pT3 and 81.8% in pT2-3N1, p < 0.0001). Three-year biochemical recurrence-free survival was 87.1% for pT2N0 and 50% for pT3N0/N1 disease (p = 0.025), and 84.2% overall. Univariate analysis for age, preoperative PSA, postoperative Gleason score, pathological stage, and margin status showed that only margin status could be used as a predictor for biochemical recurrence. CONCLUSION: Predicting factor for biochemical recurrence after LRP was positive SM status. From the oncological result, LRP in our experience is a safe and efficacious therapy for localized prostate cancer with acceptable and was consistent with results of previous studies.
Assuntos
Laparoscopia , Recidiva Local de Neoplasia , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata , Idoso , Biomarcadores/sangue , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/diagnóstico , Avaliação de Resultados em Cuidados de Saúde , Modelos de Riscos Proporcionais , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To determine technical aspects, preoperative data and perioperative outcomes in 100 cases of Laparoscopic Radical Prostatectomy (LRP) in Rajavithi Hospital. MATERIAL AND METHOD: Retrospective study from October 2005 to January 2010, the first 100 consecutive patients who underwent LRP by the same surgeon were assessed in Rajavithi Hospital. Mean age, clinical stage, preoperative PSA level, Gleason score, operative time, estimated blood loss, perioperative complications, pathological stage and margin status were recorded and analyzed. Statistical analysis is shown in median (Q1-Q3), means +/- SD. RESULTS: The mean age was 67.9 +/- 6.5 years and preoperative PSA was 19.28 (0.39-105.10) ng/dl. The most clinical stage was T1c (64.8%), Median operation time was 425 (360-600) minutes and blood loss was 1,400 (800-2,475) ml. Laparoscopic bilateral pelvic lymph node dissection was 60 cases and pathologic positive lymph node was 8 cases (13%). The positive surgical margin rate was 21.6%. There were 28 post-operative complications: urine leakage more than 2 weeks (11 cases), rectal injury (10 cases), hematoma (3 cases), lymphatic leakage more than 2 week (3 cases), DVT (1 cases). Median catheter time was 7 (6-25) days. CONCLUSION: Laparoscopic radical prostatectomy is a feasible option for the surgical treatment of localized prostate cancer LRP can help improve vision and outcome of pelvic surgery which depends on clinical stage and learning curve.
