RESUMO
OBJECTIVE: To evaluate the results of oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) during the first five years experience in Siriraj hospital. MATERIALS AND METHOD: Between September 2004 and September 2009, the functional and oncological outcomes of 559 patients that underwent LRP were retrospectively evaluated. RESULTS: The distribution of pathological T stage was T2 (52.1%), T3 (39.9%), and T4 (2.9%). Lymph node metastasis (N1) were found in 19 patients (3.4%). The positive margin rates in pT2a-b, pT2c, pT3a, pT3b and pT4 were 13.2%, 34.7%, 65.9%, 72.7% and 76.9%, respectively. The 3-year biological progression free survival (bPFS) rate for all patients was 87.2%. Three-year bPFS rates in pT2a-b, pT2c, pT3a, pT3b and pT4 were 96.3%, 93%, 75%, 55.6% and 62.5% respectively. The continent rate at 12 months was 84% and potency rate at 12 months in group that received bilateral nerve sparing was 29.1%. CONCLUSION: The oncological and functional results of our first LRPs in Thai men are acceptable and compared well with the early experience of previous studies. However, longer follow up is needed for further evaluation.
Assuntos
Laparoscopia , Próstata/inervação , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil/etiologia , Seguimentos , Hospitais de Ensino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Próstata/patologia , Próstata/cirurgia , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Taxa de Sobrevida , Tailândia/epidemiologia , Resultado do Tratamento , Incontinência Urinária/etiologiaRESUMO
OBJECTIVE: To evaluate perioperative outcomes and morbidity of laparoscopic radical prostatectomy in Siriraj Hospital during a 5-year experience. MATERIAL AND METHOD: Five hundred fifty nine patients who underwent laparoscopic radical prostatectomy (LRP) by seven surgeons at Siriraj Hospital between September 2004 and September 2009 were included in the study. Data of perioperative results and postoperative parameters were retrospectively evaluated. RESULTS: Mean operative time was 257 minutes SD 75 (range 125 to 680 min). The mean operative time of the first 100 cases was significantly higher than of the last 100 cases (307 ml/min SD 95 versus 223 ml/min SD 56; p-value = 0.001). Mean estimated blood loss was 779 ml SD 607 (range 40 to 6,000 ml). Of 559 patients, 148 patients (26.5%) had blood transfusions. The blood transfusion rate in the first 100 cases was significantly higher than those of the last 100 cases (36.5% versus 15%; p-value = 0.016). The median duration of catheterization time was 8 days. The mean time of drain insertion was 4.2 days SD 1.8 (range 2 to 18 days) postoperatively. Hospital stay was 8.8 days SD 7.6 (range 3 to 149 days). Overall perioperative complications rate was 17.1%. Of these patients, 13.4% were minor complication (Clavien 1, 2) and 3.7% were major complication (Clavien 3, 4). There were no mortalities. Late complication rate was 2.1%, which most of them were stricture of anastomosis. CONCLUSION: Perioperative outcomes and morbidity of LRP in a 5-year period were acceptable. Laparoscopic radical prostatectomy is technically demanding with an initially longer operative time and higher blood transfusion rate. The learning curve of the surgical team is needed to achieve good results.
