A Comparative Study Of Laparoscopic And Open Radical Prostatectomy

Background and purposeFor clinically localized prostate cancer,radical prostatectomy is still the "gold standard" treatment.Laparoscopic radical prostatectomy is well developed recent decades,in 2006,35%(31 500) of all radical prostatectomies performed nationwide were performed using a laparoscopic or robotic approach.Data from multi-centers and from experienced surgeons demonstrates that laparoscopic radical prostatectomy appear to be comparable to outcomes that are almostly the same with open radical prostatectomy series.The aim of this article is attempt to compare the results of the open(ORP) with the laparoscopic(LRP) approach and report it.MATERIALS AND METHODS:1.Including and excluding standard:1.1 Including standard:patients with prostate cancer with clinical stage T1b-T2c and confirmed as pathologically.All these cases have received standard laproscopic/open radical prostatectomy. 1.2 Excluding standard:patients with benign prostatic hyperplasia,prostate cancer with clinical stage surpass T2c,and those with metastasis are all excluded.2.Assemble the data:Between July 2002 and December 2008,a total of 19 consecutive men with clinically localized prostate cancer underwent radical prostatectomy,laparoscopic in 11 and open in 8.The surgical approach was selected by the patient.Preoperative staging, respective surgical techniques,pathological examination and follow up were uniform. Functional outcome was measured by patient completed health related quality of life questionnaire.We gathered the detailed clinical data of these patients,including age,sex,pathologic diagnosis,total operation time,blood loss,blood transfusion,time to indwelling urinary catheter,time of postoperative hospital stay,postoperative complications,etc.RESULTS1.Between July 2002 and December 2008,a total of 19 consecutive men with clinically localized prostate cancer underwent radical prostatectomy,laparoscopic in 11 and open in 8.11patients were treated by laparoscopic radical prostatectomy,All but only 1 conversions to open surgery,the rate of conversions was 9%.Mean patient age was 69.72±6.630years,mean operative time was 323.5±139.48min,mean estimated blood loss was 710±703.92ml,there were two postoperative complications(18%).2.8 patients were treated by open radical prostatectomy,Mean patient age was 62.5±5.63years,mean operative time was 175.62±70.68min,mean estimated blood loss was 1500±927.36ml,there were three postoperative complications(37%).3.Positive surgical margin rates(0%),Laparoscopic radical prostatectomy was associated with less pain(LRP3'vsORP4'),less time of catheter to detain,less blood loss(mean ml 710 vs 1,500,P＜0.05) and lower overall transfusion rate(54%vs 78%). Patients who underwent laparoscopic radical prostatectomy were less likely to become continent than those treated with open radical prostatectomy,and the time of postoperative hospital stay was also less(LRP24dvsORP27d,P＞0.05),but longer operative time was needed in LRP(P＜0.05).No significant difference was noted in cardiovascular,thromboembolic and PSA recurrence.CONCLUSIONS:The study showed that laparoscopic radical prostatectomy and open radical prostatectomy provided that they have comparable efficacy.Laparoscopic radical prostatectomy was associated with less blood loss and a lower transfusion rate,and also less pain,the time of postoperative hospital stay was also less.While the recovery of continence was superior after open radical prostatectomy.