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Eur Urol. 2009 May;55(5):1014-9. doi: 10.1016/j.eururo.2008.10.036. Epub 2008 Nov 6.

Oncologic outcome after laparoscopic radical prostatectomy: 10 years of experience.

Author information

1
Department of Surgery, Service of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. touijera@mskcc.org

Abstract

BACKGROUND:

While the published short-term oncologic outcomes after laparoscopic radical prostatectomy (LRP) are encouraging, intermediate and long-term data are lacking.

OBJECTIVE:

We analyzed the oncologic outcome after LRP based on 10 yr of experience.

DESIGN, SETTING, AND PARTICIPANTS:

This retrospective analysis of data prospectively collected from 1998 to 2007 studies 1564 consecutive patients with clinically localized prostate cancer (cT1c-cT3a) who underwent LRP.

INTERVENTION:

LRP was performed by two surgeons at either L'Institut Mutualiste Montsouris (IMM) in Paris, France, or Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City, USA.

MEASUREMENTS:

Progression of disease was defined as a prostate-specific antigen (PSA) of >or=0.1 ng/ml with confirmatory rise or initiation of secondary therapy. Patients were stratified as low, intermediate, or high risk based on the pretreatment prostate cancer nomogram progression-free probability of >90%, 89-71%, and <70%, respectively.

RESULTS AND LIMITATIONS:

The overall 5-yr and 8-yr probability of freedom from progression (PFP) was 78% (95% confidence interval [CI], 74-82%) and 71% (95% CI, 63-78%), respectively. For low-, intermediate-, and high-risk cancer, the 5-yr PFP was 91% (95% CI, 85-95%), 77% (95% CI, 71-82%), and 53% (95% CI, 40-65%), respectively. Surgical margins (SMs) were positive in 13% of the cases. Nodal metastases were detected in 3% of the patients after limited pelvic lymph node dissection (PLND) and in 10% after a standard PLND (p<0.001). The 3-yr PFP for node-positive patients was 49%. There were 22 overall deaths and 2 deaths from prostate cancer.

CONCLUSIONS:

LRP provided 5- and 8-yr cancer control in 78% and 71% of patients, respectively, with clinically localized prostate cancer and in 53% of those with high-risk cancer at 5 yr. A PLND limited to the external iliac nodal group is inadequate for detecting nodal metastases.

PMID:
19013010
PMCID:
PMC2962532
DOI:
10.1016/j.eururo.2008.10.036
[Indexed for MEDLINE]
Free PMC Article
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