Laparoscopic radical prostatectomy: Preliminary result of Thailand series

Abstract

Objectives: Several published series from Western countries have demonstrated that laparoscopic radical prostatectomy is a safe and feasible approach to the management of localized prostate cancer. The authors report the initial experience with the first 56 cases of laparoscopic radical prostatectomy. Material and Method: Between June 2001 and November 2005, 56 patients with clinically localized prostate cancer underwent transperitoneal laparoscopic radical prostatectomy. Their mean (range) age was 64.98 (50-77) years, prostate specific antigen (PSA) level was 9.92 (2.1-33.8) ng/ml, and Gleason sum was 6.28 (3-8). Results: Complete laparoscopic removal of the prostate was achieved in 47 cases and conversions to open surgery were needed in 9 cases. The mean (range) operating time was 350 (200-750) min. and blood loss was 883 (200-2050) ml. The transfusion rate was 27.6%. Laparoscopic pelvic lymphadenectomy was done in 31 cases and all were negative. The positive surgical margin rate was 29.8%. There were 20 postoperative complications; catheter dislodged (2), urine leakage more than 2 weeks (5), peroneal nerve numbness (1), flank hematoma (1), pelvic collection (1), late recto-urethral fistula (1), anastomotic stricture (2), port site hernia (1), and inguinal hernia (6). Median catheter time was 7 (6-90) days. The complete continence rate at 3, 6 and 12 months were 27.7%, 55.9% and 72.2%. Conclusion: Laparoscopic radical prostatectomy is a demanding procedure that is a feasible option for the surgical treatment of localized prostate cancer. Intraoperative results were improved once experience was gained. Some parameters of the present results, i.e. transfusion rate, positive surgical margin and continence rate were still inferior compared to those reported by other centers.