Clinical Comparative Of Curative Effect Of Different Routes For Laparoscopic Radical Prostatectomy

ObjectiveTo compare and evaluate the outcomes and security between extraperitoneal laparoscopic radical prostatectomy and transperitoneal laparoscopic radical prostatectomy as the treatment of prostate callcer. MethodsThe clinical datas of 22 cases of patients received transperitoneal laparoscopic radical prostatectomy plus Pelvic lymph node dissection and 13 cases of patients received extraperitoneal laparoscopic radical prostatectomy plus Pelvic lymph node dissection were analyzed retrospectively at our institute between March 2010 and Apr 2014.Indexes of age,preoperative BMI,preoperative serum PSA,preoperative GS score,c-TNM,operating time,bleeding volume during operation,rate of blood transfusions, postoperative pain,recovery time of intestinal function,hospitalization stay after operation, the duration of catheterization,complication,p-TNM, continence rate,potency rate,and recurrence of the procedures were compared. Results1.35 patients were all successfully performed by laparoscope.No one was converted to open surgery. The average age,BMI,preoperative serum PSA,preoperative GS score,c-TNM and the volume of prostate of TLRP group and the ELRP group, and there were no statistical difference between these two groups(P>0.05).2.The mean operating time of TLRP group was longer than the ELRP group,(308.6±87.6)min and(211.6±96.5)min respectivly, and there was statistical difference between the two groups(P<0.01);The mean bleeding volume durning operation of TLRP group was more than the ELRP group,(416.9±108.4)ml and(325.6±133.7)ml respectivly,there was statistical difference between the two groups(P<0.05);The duration of catheterization of TLRP group was longer than the ELRP group,(19.25±4.72)d and(13.43±5.06)d respectivly,there was statistical difference between the two groups(P<0.01);The hospitalization of TLRP group was longer than the ELRP group,(14.54±4.45)d and(11.56±3.32)d respectivly,there was statistical difference between these two groups(P<0.05).3.There were 6 cases with intraoperative complications in TLRP group and There were 2 cases with intraoperative complications in ELRP group; There were 5 cases with postoperative complications in TLRP group and there were 5 cases with postoperative complications in ELRP group; and there were no statistical difference between two groups.4. 35 patients were followed up for 13~50 months,and the median time was 31 months. By the end of the follow-up date, in the TLRP group and ELRP group,the one-year biochemical recurrence rate was 13.64%(3/22)and 15.38%(2/13) respectivly; there was no statistical difference between the two groups(P>0.05).In the TLRP group and ELRP group, the continence rare when pull the urine tube was 22.72%(5/22) and 46.15%(6/13)respectivly; the six-month continence rate was 54.55%(12/22)and 76.92%(10/13)respectivly, there was statistical difference between these two groups(both P<0.05). But there was no statistical difference between these two groups in the one-year continence rate(P>0.05). In TLRP group,there were 9 cases(normal sexual function) and 3 cases(mildly abnormal sexual function), that had restored the sexual function after nerve-sparing radical prostatectomy.In the postoperation, 9 cases(75.0%)restore sexual function. In ELRP group,there were 5 cases(normal sexual function) and 2 cases(mildly abnormal sexual function), that had restored the sexual function after nerve-sparing radical prostatectomy. In the postoperation,4 cases(57.14%)restore sexual function. Conclusion1. Compared with ELRP,TLRP has more space,and the tension is smallinvesicourethral anastomosis.The nerve,blood vessel bundle were easy to identifyand retain them,moreover,it is more convenient to expand the pelviclymph nodes dissection.2. Compared with TLRP, ELRP has it’s own advantage, for example the small ofintraoperative trauma, short operation time, fewer intraoperative complications,quicker recovery, etc.3. ELRP or TLRP have the equivalent oncological and functional results, howeverELRP is superior to TLRP with respect to faster recovery of continence.