Oncologic outcome after laparoscopic radical prostatectomy: 10 years of experience Journal Article
| Authors: | Touijer, K.; Secin, F. P.; Cronin, A. M.; Katz, D.; Bianco, F.; Vora, K.; Reuter, V.; Vickers, A. J.; Guillonneau, B. |
| Article Title: | Oncologic outcome after laparoscopic radical prostatectomy: 10 years of experience |
| 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 ≥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. © 2008 European Association of Urology. |
| Keywords: | immunohistochemistry; adult; aged; disease-free survival; middle aged; survival analysis; surgical technique; retrospective studies; major clinical study; overall survival; disease course; cancer growth; cancer risk; united states; cancer staging; outcome assessment; follow-up studies; lymph node metastasis; lymph node dissection; lymph nodes; neoplasm staging; laparoscopy; laparoscopic surgery; prospective study; lymph node excision; prostate specific antigen; progression free survival; cohort studies; neoplasm recurrence, local; retrospective study; risk factor; cancer mortality; time factors; risk assessment; prostate cancer; postoperative complications; confidence intervals; prostate-specific antigen; prostatic neoplasms; cancer center; probability; prostatectomy; surgery; cancer control; nomogram; france; prostate neoplasm |
| Journal Title: | European Urology |
| Volume: | 55 |
| Issue: | 5 |
| ISSN: | 0302-2838 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2009-05-01 |
| Start Page: | 1014 |
| End Page: | 1019 |
| Language: | English |
| DOI: | 10.1016/j.eururo.2008.10.036 |
| PUBMED: | 19013010 |
| PROVIDER: | scopus |
| PMCID: | PMC2962532 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 11" - "Export Date: 30 November 2010" - "CODEN: EUURA" - "Source: Scopus" |
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