Efficacy Of Extra-peritoneal Laparoscopic Radical Prostatectomy In The Treatment Of High-risk Prostate Cancer

Objective:To investigate the efficacy and feasibility of extra-peritoneal larparoscopic radical prostatectomy (eLRP) in the treatment of patients with high-risk prostate cancer (HRPC).Methods:from February 2009 to December 2013,121 patients, who were diagnosed as HRRC according to the D’Amico definition, were received eLRP. The mean age was 70 years old (range 54-82 years old). The mean PSA level was 25.45 (range 2.40-111.31) μg/L and mean Gleason score was 8 (range 6-10). The classification of clinic stage in this study included 52 cases in cT1-cT2a/b,58 cases in cT2C,8 cases in cT3a, and 3 cases in cT3b, respectively. The perioperative data were collected, including operative time, blood loss, intraoperative complications, urine leakage, lymph leakage, incontinent ability, erectile function and changing PSA levels.Results:All the operations were successfully performed. The mean operative time was 165 minutes (range 105-341min), the average blood loss was 150 ml (range 50～1500ml). The intraoperative complications included hemorrhage in 4 cases and intra-operative obturator nerve injury in 3 cases. The mean duration of intestinal function recovery was 35h (range 24～72h). The mean interval of catheter indwelling was 9 days(range 7～ 14d). The anastomotic leakage was found in 12 cases, including 1 day after surgery in 5 cases,2 days after surgery in 3 cases,3 days after surgery in 12 cases,4 days after surgery in 1 case and 5 days after surgery in 1 case. The anastomotic stricture in 3 cases within 2 to 4 months after operation, which the symptom improved after urethral in 2 cases and urethrotomy in 1 case. Deep vein thrombosis was noticed in 1 case 5 days after the procedure. And lymphatic fistula was recorded in 1 case after the operation. Positive surgical margin, seminal vesicle invasion, and positive iliac vessel lymph node were found in 18,21, and 9 patients, respectively. The mean hospitalization duration was 10 days(range 5～22d). Of the 107 patients followed-up,96 patients were continent in 1 year, except other 11 patients. Nerve sparing procedure was performed in 51 patients, and thirty-three of them were potent. The mean PSA level was 0.14μg/L(range 0～8.75μg/L)six weeks after the surgey.22 patients had biochemical recurrence with 5～36 months followed-up, mean 18 months.Conclusion:Extraperitoneal LRP is an efficacious approach for patients with high-risk prostate cancer.