Since Guillonneau and Vallancien reintroduced transperitoneal laparoscopic radical prostatectomy in 1998, several other medical institutions in Europe have published their series and confirmed that laparoscopic radical prostatectomy (LRP) is a feasible and reproducible approach to the management of clinically localized prostate cancer; however, there have been few reports from North American medical institutions. We now report the results of our first 200 consecutive cases of LRP in a Canadian Medical Institution.
From February/2000 until April/2003, laparoscopic radical prostatectomy was performed on 200 out of 205 surgical candidates for radical prostatectomy. There were 120 transperitoneal laparoscopic radical prostatectomies (TP-LRP) and 80 extraperitoneal laparoscopic radical prostatectomies (EP-LRP). TP-LRP was based on posterior access to the seminal vesicles whereas EP-LRP was based on trans-bladder neck approach to the seminal vesicles. Patients' mean age was 63.5 (range 42-75). Patients were separated into two groups of 100 patients in order to assess the impact of the learning curve.
There were 147 with pT2 disease and 53 with pT3 disease with a positive surgical margin of pT2a (0%), pT2b (20%), PT3a (52%) and pT3b (53%) respectively. The overall positive surgical margin rate is 27%. The median follow-up is 13 months. There were 111 patients available for a one-year follow-up with PSA recurrence-free rate of 95%. The positive surgical margin rates for low, intermediate and high-risk categories are 19%, 40%, and 63% respectively. The 6-month continence rate available in 160 patients was 88.2%. Spontaneous erection was reported in 21 out of the 46 patients (46%) with at least 6 months follow-up. The intra-operative and post-operative complication rate was 20% for Group 1 and 4% for Group 2 with an overall rate of 8%. The overall surgical time was 4.4 hours for Group 1 and 3.3 hours for Group 2. The hospital stay was 5.26 days for Group 1 and 2.44 days for Group 2. Transfusion rate was 8% for Group 1 and 2% for Group 2. The mean analgesic requirement in the last 50 cases was 5.5 mg of morphine with 58% of patients being analgesic-free post-operatively.
Laparoscopic radical prostatectomy is a technically demanding procedure with a long and gradual learning curve. The present study confirms the impression of other large published series in that it appears to offer equivalent oncologic results and functional results when compared with open radical prostatectomy. The preservation of potency will require longer follow-up. Longer follow-up and large randomized control studies will be required to determine its exact role in the surgical management of clinically localized prostate cancer.