Abstract

CREGO TAPIAS, M. et al. Initial series of radical prostatectomy in a general hospital: review and comparative of national and international series. Actas Urol Esp [online]. 2008, vol.32, n.9, pp.888-893. ISSN 0210-4806.

Introduction and objectives: The radical prostatectomy is a technique that has shown competitive oncological and functional results, that is why it has become to be a routine procedure in many leading centers. Nevertheless, the difficulty of learning and its initial cost, could question its implantation as a routine technique in centers that are not a point of reference. We have carried out a descriptive study of our initial series analyzing the surgical technique, post surgical immediate results, and oncological and functional short-term outcomes, comparing them with other series in national and international centers. Methods: From February, 2006 to August, 2007 we performed 69 laparoscopical procedures in our center, of which 34 were radical prostatectomies. The average age of the series were 63 years (50-72), with a prostate average weight by transrectal ultrasound of 35 gr. (17-72), and a median PSA of 6ng/ml (4-35). The clinical stages were: T1c 59%, T2a 12%, T2b 17%, T2c 12%; with Gleason combined of: 2+2 in 3%, 3+3 in 35%, 3+4 in 15%, 4+3 in 44%, 4+5 in 3%. Results: Out of the 34 cases initiated by laparoscopy, 30 were concluded laparoscopically, with a surgical average time of 261 minutes (150-380). The pathological stages were: pT2a 3%, pT2b 18%, pT2c 41%, pT3a 32 %, pT3b 6%. With Gleason of: 3+3 in 26%, 3+4 in 14%, 4+3 in 47%, 4+4 in 9%, 4+5 in 3%. We obtained 29 % of positive margins (50% pT3a, 20% pT3b, 20% pT2b, 10% pT2c). Four cases were converted to open surgery, one due to subcutaneous emphysema, one to enlarged surgical time, one bleeding, and one rectal injury. The continence (0-1 pads) at the first month was 62%, reaching 84% at 6 months. The erection, remained in 50% of the patients at the first month, in the four cases of intrafascial dissection. Conclusions: Laparoscopic radical prostatectomy is a technique of difficult learning, and initially requires higher surgical time than open surgery.Nevertheless, we prove that it is a reliable technique with competitive oncological and functional results, earlyrecovery and little bleeding even in the initial series. Therefore, it should be considered an option for the treatment of prostate cancer also in not leading centers.

Keywords : Prostate cancer; Radical prostatectomy; Laparoscopy.

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