Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

  • Akita, Hidetoshi (Department of Urology, JA Aichi Anjo Kosei Hospital) ;
  • Nakane, Akihiro (Department of Urology, JA Aichi Anjo Kosei Hospital) ;
  • Ando, Ryosuke (Department of Urology, JA Aichi Anjo Kosei Hospital) ;
  • Yamada, Kenji (Department of Urology, JA Aichi Anjo Kosei Hospital) ;
  • Kobayashi, Takahiro (Department of Urology, JA Aichi Anjo Kosei Hospital) ;
  • Okamura, Takehiko (Department of Urology, JA Aichi Anjo Kosei Hospital) ;
  • Kohri, Kejiro (Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences)
  • Published : 2013.11.30
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Abstract

Background: While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma and evaluated the potential advantages of each. Materials and Methods: From January 2010 to December 2010, all 23 patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introduced the reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stage prostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serum PSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates and post-operative pain. Results: There was a significant difference in operative time between the 2-port RP and LRP groups ($286.5{\pm}63.3$ and $351.8{\pm}72.4$ min: p=0.0019, without any variation in blood loss (including urine) ($945.1{\pm}479.6$ vs $1271.1{\pm}871.8ml$: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RP group, but without significance ($5.6{\pm}1.8$ vs $8.0{\pm}5.6$ days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8mg/patient in 2-port RP and 50.0mg/patient in LRP. Conclusions: Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

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References

  1. Aron M, Canes D, Desai MM, et al (2009). Transumbilical single-port laparoscopic partial nephrectomy. BJU Int, 103, 516-21. https://doi.org/10.1111/j.1464-410X.2008.08007.x
  2. Autorino R, Cadeddu JA, Desai MM (2011). Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol, 59, 26-45. https://doi.org/10.1016/j.eururo.2010.08.030
  3. Autorino R, Kaouk JH, Yakoubi R, et al (2012). Urological laparoendoscopic single site surgery: multi-institutional analysis of risk factors for conversion and postoperative complications. J Urol, 187, 1989-94. https://doi.org/10.1016/j.juro.2012.01.062
  4. Castellucci SA, Curcillo PG, Ginsberg PC, et al (2008). Single port access adrenalectomy. J Endourol, 22, 1573-6. https://doi.org/10.1089/end.2008.0100
  5. Coelho RF, Palmer KJ, Rocco B, et al (2010). Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system. Eur Urol, 57, 945-52. https://doi.org/10.1016/j.eururo.2010.02.001
  6. Desai MM, Berger AK, Brandina R, et al (2009). Laparoendoscopic single-site surgery: Initial hundred patients. Urology, 74, 805-12. https://doi.org/10.1016/j.urology.2009.02.083
  7. Desai MM, Rao PP, Aron M, et al (2008). Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. BJU Int, 101, 83-8.
  8. Guilloneau B, Abbou CC, Doublet JD, et al (2001). Proposal for a European scoring system for laparoscopic operations in urology. Eur Urol, 40, 2-6.
  9. Guillonneau B, Vallancien G (2000). Laparoscopic radical prostatectomy: the montsouris experience. J Urol, 163, 1643-49. https://doi.org/10.1016/S0022-5347(05)67512-X
  10. Hakimi AA, Blitstein J, Feder M et al (2009). Direct comparison of surgical and functional outcomes of robotic-assisted versus pure laparoscopic radical prostatectomy: single surgeon experience. Urology, 73, 119-23. https://doi.org/10.1016/j.urology.2008.08.491
  11. Joseph JV, Vicente I, Madeb R, et al (2005). Robot-assisted versus pure laparoscopic radical prostatectomy: are there any differences? BJU Int, 96, 39-42. https://doi.org/10.1111/j.1464-410X.2005.05563.x
  12. Kaouk JH, Goel RK, Haber GP, et al (2008). Single-port laparoscopic radical prostatectomy. Urology, 72, 1190-3. https://doi.org/10.1016/j.urology.2008.06.010
  13. Kaouk JH, Haber GP, Goel RK, et al (2008). Single-port laparoscopic surgery in urology: initial experience. Urology, 71, 3-6. https://doi.org/10.1016/j.urology.2007.11.034
  14. Menon M, Shrivastava A, Tewari A, et al (2002). Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol, 168, 945-9. https://doi.org/10.1016/S0022-5347(05)64548-X
  15. Menon M, Tewari A, Peabody JO, et al (2004). Vattiktuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am, 31, 701-17. https://doi.org/10.1016/j.ucl.2004.06.011
  16. Murphy DG, Bjartell A, Ficarra V, et al (2010). Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications. Eur Urol, 57, 735-46. https://doi.org/10.1016/j.eururo.2009.12.021
  17. Nakane A, Akita H, Okamura T, et al (2013). Feasibility of a novel extraperitoneal two-port laparoendoscopic approach for radical prostatectomy: an initial study. Int J Urol, 20, 729-33. https://doi.org/10.1111/iju.12034
  18. Rabenalt R, Arsov C, Giessing M, et al (2010). Extraperitoneal laparo-endscopic single-site radical prostat ectomy: first experience. World J Urol, 28, 705-8. https://doi.org/10.1007/s00345-010-0534-6
  19. Rozet F, Jaffe J, Braud G, et al (2007). A direct comparison of robotic assisted versus pure laparoscopic radical prostatectomy: a single institution experience. J Urol, 178, 478-82. https://doi.org/10.1016/j.juro.2007.03.111
  20. White WM, Haber GP, Goel RK, et al (2009). Single-port urological surgery: single-center experience with the first 100 cases. Urology, 74, 801-4. https://doi.org/10.1016/j.urology.2009.04.030
  21. Willis DL, Gonzalgo ML, Brotzman M, et al (2011). Comparison of outcomes between pure laparoscopic vs robot-assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes. BJU Int, 109, 898-905.