REDUCTION IN INCIDENCE OF LYMPHOCELE FOLLOWING EXTRAPERITONEAL RADICAL PROSTATECTOMY AND PLND BY BILATERAL PERITONEAL FENESTRATION
CAN WE PREDICT PROLONGED LYMPHORRHEA IN PATIENTS SUBMITTED TO RADICAL PROSTATECTOMY AND PELVIC LYMPHADENECTOMY?
Mc Neill A.1, Wasserscheid J.2, Rabenalt R.2, Do M.2, Liatsikos E.N., Stolzenburg J.U.2
Capitanio U., Pellucchi F., Abdollah F., Briganti A., Deho F., Gallina A., Saccà A., Petralia G., Guazzoni G., Rigatti P., Montorsi F.
1 Western General Hospital, Dept. of Urology, Edinburgh, United Kingdom, 2University of Leipzig, Dept. of Urology, Leipzig, Germany, University of Patras, Dept. of Urology, Patras, Greece
Introduction & Objectives: In our series of 1700 endoscopic extraperitoneal radical prostatectomies (EERPE) the incidence of lymphocele following simultaneous PLND is EHWZHHQDQGGHSHQGLQJRQWKHH[WHQWRIO\PSKQRGHGLVVHFWLRQ:HUHSRUWWKH impact of bilateral peritoneal fenestration after completion of extraperitoneal prostatectomy and PLND on the incidence of lymphocele, post-operative pain and complications. Material & Methods: One hundred consecutive patients undergoing EERPE and extended PLND were allocated to two groups. In Group A (n=50) a 4-6cm incision was performed bilaterally over the external iliac vessels down to the obturator fossa after completion of the main procedure. In Group B (n=50) no peritoneal incisions were made. The postRSHUDWLYH DVVHVVPHQW SURWRFRO LQFOXGHG D YLVXDO DQDORJXH SDLQ VFDOH DGPLQLVWHUHG times daily for 6 days, analgesia requirement, and ultrasound examination on 4th and WKGD\VDQGPRQWKVSRVWRSHUDWLYHO\&53DQGOHXNRF\WHFRXQWVZHUHPHDVXUHGRQ the 1st and 2nd post-op days. Complications were recorded according to our standard SURWRFROXVLQJWKH&ODYLHQFODVVLᚏFDWLRQ Results: Three patients (6%) in Group A were found to have lymphoceles, none of which ZHUHV\PSWRPDWLF6LJQLᚏFDQWO\PRUHSDWLHQWVLQ*URXS%GHYHORSHGO\PSKRFHOHQ S RIZKLFKDVLJQLᚏFDQWQXPEHUZHUHV\PSWRPDWLFQ S DQG UHTXLUHGODSDURVFRSLFIHQHVWUDWLRQ1RVLJQLᚏFDQWGLᚎHUHQFHZDVREVHUYHGEHWZHHQWKH SDLQVFRUHLQHLWKHUJURXS7KHPHDQSDLQVFRUHVZHUHYVDWKRXUVDQGYV DWGD\VUHVSHFWLYHO\1RGLᚎHUHQFHLQDQDOJHVLDUHTXLUHPHQWVHUXPLQᚐDPPDWRU\ markers and return to normal bowel activity was observed between the groups. Conclusions: 7KLVVWXG\GHPRQVWUDWHVWKDWSHULWRQHDOIHQHVWUDWLRQVLJQLᚏFDQWO\UHGXFHV the incidence of both symptomatic and asymptomatic lymphocele, without an increase in post-operative morbidity. As symptomatic lymphocele is one of the most common complications of extraperitoneal PLND requiring reintervention, we recommend that peritoneal fenestration should be performed routinely after completion of EERPE and PLND.
Vita-Salute University, Dept. of Urology, Milan, Italy Introduction & Objectives: Several studies suggested that drains for lymph drainage after radical prostatectomy can be safely omitted in selected cases. The DLPRIWKLVVWXG\ZDVWRGHᚏQHWKHSUHGLFWLYHIDFWRUVRISURORQJHGO\PSKRUUKHDLQ patients with prostate cancer (PCa) undergoing radical prostatectomy (RP) and pelvic lymphadenectomy (PLND), in order to identify patients needing a pelvic drain. Material & Methods: We analyzed 416 consecutive cases of patients with SURVWDWH FDQFHU ZKR XQGHUZHQW 53 DQG 3/1' E\ HLJKW GLᚎHUHQW VXUJHRQV DW our institution. All patients had detailed clinical and pathological data recorded prospectively in a database. The criteria of inclusion were a successful bladder neck preservation and a watertight urethrovescical anastomosis at the end of the procedure. Drains were removed when the amount of lymph was less than 20cc in the last 24 hours. Univariate and multivariate linear regressions models tested WKHDVVRFLDWLRQEHWZHHQRXUYDULDEOHV>QXPEHURIUHPRYHGQRGHVDJHDWVXUJHU\ surgical volume, pathological T stage, nodes status (negative vs. positive), body mass index, presence of comorbidities (Charlson index)] and total lymphorrea. Results: 0HDQ QXPEHU RI QRGHV UHPRYHG ZDV UDQJH 0XOWLYDULDWH regression analysis showed that high number of removed nodes (p<0.01), old age DWVXUJHU\S DQGORZVXUJLFDOYROXPHS ZHUHFRUUHODWHGVLJQLᚏFDQWO\ with total lymphorrhea after RP and PLND. Pathological T stage, nodes status (negative vs. positive), body mass index, presence of comorbidities (Charlson index) were not correlated with our endpoint (all p>0.2). Conclusions: The number of nodes removed, age at surgery and the surgical volume are the only variables which can predict prolunged limphorrhea after RP and PLND. These variables may help urologists to determine when a pelvic drain cannot be safely omitted.
EARLY AND LATE COMPLICATIONS AFTER 1253 ROBOT-ASSISTED AND 485 OPEN RETROPUBIC PROSTATECTOMIES AT KAROLINSKA UNIVERSITY HOSPITAL
IS ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY LESS INVASIVE THAN RETROPUBIC RADICAL PROSTATECTOMY? RESULTS FROM A PROSPECTIVE, NON RANDOMISED, COMPARATIVE STUDY
Carlsson S., Nilsson A.E., Jonsson N.M., Wiklund N.P.
Fracalanza S.1, Galfano A.1, Iafrate M.1, Novara G.2, Cavalleri S.1, Artibani W.1, Ficarra V.1
Karolinska University Hospital, Dept. of Urology, Stockholm, Sweden 1
Introduction & Objectives: Objective: Patients diagnosed with localised prostate cancer is forced to take a number of complex problems in to consideration when choosing between GLᚎHUHQW WKHUDSHXWLF RSWLRQV ,Q PRVW FDVHV WKH SDWLHQW LV SUHGRPLQDQWO\ FRQFHUQHG ZLWK oncological and functional outcome due to its impact on future quality of life. However, FRPSOLFDWLRQVWRWKHUDS\PD\DOVRDᚎHFWIXWXUHTXDOLW\RIOLIH7KHREMHFWLYHRIWKLVVWXG\ZDV to quantify early and late complications after radical surgery for localised prostate cancer at our institution. Material & Methods: 3DWLHQWVDQG0HWKRGV%HWZHHQ-DQXDU\DQG$XJXVW consecutive men diagnosed with localised prostate cancer underwent radical prostatectomy at Karolinska University Hospital. The 485 retropubic procedures were performed by nine GLᚎHUHQW VXUJHRQV VL[ RI WKHVH VXUJHRQV SHUIRUPHG URERWDVVLVWHG SURFHGXUHV 'DWD concerning reoperations, blood transfusions, anastomotic leakage, urethral strictures and surgery for urinary incontinence was collected retrospectively for all the patients through central complication registers and patient charts. Baseline characteristics were prospectively collected. Results: 0HDQ36$IRUWKHUHWURSXELFDQGURERWDVVLVWHGJURXSVZHUHUDQJH DQG UDQJH UHVSHFWLYHO\ ,Q WKH UHWURSXELF JURXS WKHUH ZHUH 7F tumours compared to 770 (61.5 %) in the robot-assisted group. Blood transfusions were given WR SDWLHQWV LQ WKH UHWURSXELF JURXS DQG LQ WKH URERW assisted group, respectively. Anastomotic leakage was seen in 21 (1.2 %) patients, 8 (1.5 %) LQWKHUHWURSXELFJURXSDQG LQWKHURERWDVVLVWHGJURXSUHVSHFWLYHO\6XUJLFDOUH interventions were necessary in 12 (2.5 %) and 18 (1.4 %) after retropubic and robot-assisted surgery, respectively. Surgery for urinary incontinence was more common after open surgery, FRPSDUHGWR 8UHWKUDOVWULFWXUHVZHUHWUHDWHGLQ SDWLHQWVZKR had undergone retropubic surgery compared to 2 (0.1 %) in patients operated with the robot. &RQYHUVLRQWRRSHQVXUJHU\ZDVSUHIRUPHGLQ SDWLHQWVLQWKHURERWDVVLVWHGJURXS Conclusions: The overall complication rate is low after radical prostatectomy irrespective if URERWDVVLVWHGRURSHQUHWURSXELFVXUJHU\ZDVSUHIRUPHG$FRPSDULVRQEHWZHHQWKHGLᚎHUHQW surgical techniques is hampered by the fact that there were fewer patients per surgeon in the retropubic group and that the tumours were more advanced. Even though this is taken in to consideration it seems that robot-assisted radical prostatectomy has a lower complication rate than retropubic prostatectomy at our institution.
Eur Urol Suppl 2008;7(3):302
University of Padua, Dept. of Oncology and Surgical Sciences, Urology Clinic, Padua, Italy, 8QLYHUVLW\ RI 3DGXD 'HSW RI 2QFRORJ\ DQG 6XUJLFDO 6FLHQFHV 8URORJ\ &OLQLF ,5&&6 Institute Oncology Veneto (IOV), Padua, Italy
Introduction & Objectives: The laparoscopic approach is usually considered less traumatic than the surgical one. Experimental studies suggest acute phase reaction to be proportional to VXUJHU\LQGXFHGWLVVXHGDPDJH8SWRGDWHQRFOLQLFDOVWXG\GHPRQVWUDWHGDGLᚎHUHQWDFXWH phase reaction in patients undergoing laparoscopic or open radical prostatectomy. The purpose of the present study is to evaluate whether robot-assisted laparoscopic prostatectomy (RALP) produces lower tissue damage than radical retropubic prostatectomy (RRP). Material & Methods: Between May and November 2006, all patients undergoing RRP or RALP for clinically localized (cT1-2) prostate cancer in our department have been prospectively studied. The study protocol included the collection of blood samples dosing interleukin 6 (IL-6), interleukin 1 alpha (IL-1), C-reactive protein (CRP), and lactate, 24 hours before (T0), GXULQJVXUJHU\7 DWWKHHQGRIDQHVWKHVLD7 7 DQGKRXUVDIWHUVXUJHU\7 ,Q patients undergoing RALP, the intra-operative blood sample was collected before the incision RI WKH YHVLFRSURVWDWLF MXQFWLRQ LQ WKH VXUJLFDO 553 JURXS WKH LQWUDRSHUDWLYH EORRG VDPSOH was collected before the endopelvic fascia incision. Mann- Whitney U test, Student’s T and Friedman tests were used to compare continuous variables, Pearson chi-square and Fisher WHVWIRUFDWHJRULFDOYDULDEOHV$WZRVLGHGSZDVFRQVLGHUHGVLJQLᚏFDQW Results: 5$/3DQG553SDWLHQWVZHUHVWXGLHG0HGLDQDJHZDVLU LQWKH RALP and 68.5 (i.r. 59.2-71,2) in the RRP group (p<0.009). Baseline levels (T0) of IL-1, IL-6, CRP and lactate were comparable in both arms. Median IL-6 and CRP values recorded a VLJQLᚏFDQWLQFUHDVHLQWKHZKROHVDPSOHGXULQJDOOWKHVWXGLHGSHULRGS 7KHLQFUHDVH UHVXOWHGVLJQLᚏFDQWO\KLJKHULQSDWLHQWVZKRKDGXQGHUJRQH553DWWKHIROORZLQJWLPHSRLQWV HQG RI DQHVWKHVLD 7 S KRXUV 7 S DQG KRXUV DIWHU VXUJHU\ 7 (p<0.001). The values of IL-1 alpha did not change during the study. Median variations of ODFWDWHYDOXHVUHPDLQHGEHORZWKHWKUHVKROGIRUDEQRUPDOLW\1HYHUWKHOHVVVLJQLᚏFDQWGLᚎHUHQFH EHWZHHQWKHWZRJURXSVZHUHIRXQGLQ7S 7S DQG7S Conclusions: The lower blood increase of IL-6, CRP and lactates recorded in patients XQGHUJRLQJ5$/3GHPRQVWUDWHVIRUWKHᚏUVWWLPHLQ/LWHUDWXUHWKDW5$/3LQGXFHVDORZHUWLVVXH traumatism than RRP.