Laparoscopic radical prostatectomy: oncological evaluation in the early phase of the learning curve comparing to retropubic approach.

OBJECTIVES

Radical prostatectomy is actually the gold-standard treatment for organ-confined prostate cancer. Since Schuessler et al. performed the first laparoscopical radical prostatectomy (LRP) in 1992 this surgical approach for prostate cancer treatment has been widely diffused among european urologists. In this study we report our initial experience with laparoscopic surgery focusing on the oncological assessments and comparing these results to those of the retropubic approach.

MATERIAL AND METHODS

Between March 2002 and November 2003, 50 laparoscopic radical prostatectomy were performed at our Institute. We reviewed the operative times, intraoperative complications, mean catheterization and postoperative hospital stay of these first 50 cases. Moreover during the same period a group of 50 consecutive patients underwent retropubic radical prostatectomy (RRP) and data were analyzed and compared to laparoscopic issues. The laparoscopic approach was performed according to the Montsouris technique. Patient age, Gleason score at biopsy, PSA and clinical stage of the two groups were compared. Positive margins of the two groups were compared in relation to their location and pathological stage.

RESULTS

No significative statistical differences of age, preoperatory PSA, Gleason score at biopsy and clinical stage were observed between the two groups (p > 0.05). Also in post-operative data no significative statistical differences regarding the pathological stage (p = 0.54) and the Gleason score (p = 0.714) were noted between the two groups. In RRP group the pathological stage was pT2 in 28 patients and pT3 in 22 patients; in LRP group was pT2 in 31 patients and pT3 in 19 patients. The mean Gleason score resulted 6.16 in RRP group and 6.10 in LRP group. The number of positive surgical margins was low in both groups and the location was similar in retropubic and laparoscopic specimens. We reported 13 positive surgical margins in RRP group and 12 in LRP (p = 0.8).

CONCLUSIONS

Basing on our initial experience with 50 patients we can affirm that laparoscopic radical prostatectomy can be performed with a lower morbidity and oncological results similar to the retropubic approach even in the early phase of the learning curve. Our experience could be useful to encourage all the urologists approaching laparoscopy.