Experiencia inicial en prostatectomía radical laparoscópica

Abstract

Background

The era of prostate-specific antigen screening has produced an increase in the incidence of localized prostate cancer. Radical surgery is the gold standard for patients that are candidates for curative tratment.

Aim

To describe the initial experience with laparoscopic radical prostatectomy (LRP) at a tertiary care referral center.

Material and method

The cohort of patients that underwent radical prostatectomy within the time frame of January 2013 to June 2015 was reviewed. Eleven patients that underwent LRP, all operated on by the same surgeon, were included in the study. Demographic variables, comorbidities, and preoperative, intraoperative, and postoperative variables were analyzed. Biochemical recurrence and surgical margins were the oncologic variables evaluated. Descriptive statistics using the SPSS® version 20 statistical software package were carried out, performing frequency, means plus standard deviation, and median with range analyses.

Results

The mean age of the patients was 62.7 years with a standard deviation of ± 7.3. The majority of the presurgical cases were low-risk. A presurgical understaging trend was observed, given that 33% of patients were classified as high-risk after LRP. Follow-up time was 8 months (± 3.1). Two laparoscopic surgeries were converted for the surgeon's convenience to perform urethrovesical anastomosis. Blood loss, surgery duration, and hospital stay means were 380 ml (240-2,500), 300 min (105-615), and 4 days (3-10), respectively. The transfusion rate was 18% and the mean time with transurethral catheter was 7.9 days (6-9.7). Bilateral nerve-sparing surgery was performed in 100% of the cases. Urinary continence was achieved in 72.7% of the cases at one month after surgery, with an improvement trend from the third month to one year of follow-up. Erectile function was preserved in 55% of the cases and the positive margin rate was 45%. Prostate-specific antigen was undetectable at one month after LRP in 64% of the cases. The so-called trifecta outcome was met at one month after surgery in 36% of the patients and an incidence of 18% was reported in relation to postoperative complications.

Conclusions

We presented the initial experience with LRP at our hospital. LRP appears to be a safe technique with acceptable functional and oncologic results. Ours is a first series that must be updated as the learning curve moves closer to reaching its final plateau.