Long‐term oncological outcomes after laparoscopic radical prostatectomy

• Published in: BJU international Vol. 111; no. 2; pp. 271 - 280
• Main Authors: Hruza, Marcel, Bermejo, Justo Lorenzo, Flinspach, Bettina, Schulze, Michael, Teber, Dogu, Rumpelt, Hans Joachim, Rassweiler, Jens Jochen
• Format: Journal Article
• Language: English
• Published: Oxford Wiley-Blackwell 01.02.2013; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Androgen Antagonists - therapeutic use; Biological and medical sciences; Chemotherapy, Adjuvant; Epidemiologic Methods; Gynecology. Andrology. Obstetrics; Humans; laparoscopy; Laparoscopy - methods; Laparoscopy - mortality; Lymph Node Excision; Lymphatic Metastasis; Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Nephrology. Urinary tract diseases; oncological outcomes; Operative Time; Prostate cancer; prostatectomy; Prostatectomy - methods; Prostatectomy - mortality; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Radiotherapy, Adjuvant; Treatment Outcome; Tumor Burden; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Endoscopic surgery; Nephrology; Urinary system disease; Prognosis; Prostate disease; Laparoscopic surgery; Laparoscopy; Malignant tumor; Long term; Urology; oncological outcomes; Treatment; Prostatectomy; Endoscopy; Male genital diseases; Prostate cancer; Cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2012.11317.x

What's known on the subject? and What does the study add? Laparoscopic radical prostatectomy (LRP) has shown good oncological short‐term and mid‐term outcomes, but long‐term outcomes are still lacking. We present long‐term oncological outcomes of LRP in a large cohort of patients operated on in one of the pioneering European centres. The data from the present study show high rates of biochemical and clinical recurrence‐free survival and low cancer‐specific mortality compared with open series. Objectives To investigate long‐term oncological outcomes after laparoscopic radical prostatectomy (LRP). To identify parameters influencing recurrence‐free survival in a single‐institution series. Patients and Methods All patients underwent LRP using the transperitoneal retrograde Heilbronn technique. High‐risk patients received adjuvant treatment according to an institutional algorithm based on prostate‐specific antigen (PSA), Gleason score, tumour‐node‐metastasis stage, margin status and tumour volume. Data were collected prospectively on operative and postoperative parameters beginning in 1999. Complete follow‐up data of 370 of the first 500 consecutive patients are available. Biochemical recurrence was defined as two consecutive PSA levels <0.2 ng/mL within the follow‐up period. Kaplan–Meier estimates and Cox regression were applied to examine recurrence‐free survival times. Results The estimated biochemical recurrence‐free survival (BCRFS) rates 10 years after LRP were 80.2% in patients staged pT2, 47.4% in those staged pT3a and 49.8% in those staged pT3b/4, confirming a better prognosis in patients with organ‐confined disease (P < 0.001). In the multivariate Cox regression analysis, only Gleason score and pT stage significantly influenced BCRFS. The 10‐year clinical progression‐free survival rates were 97.2% (pT2), 84.4% (pT3a) and 78.1% (pT3b/4), and prostate cancer‐specific survival estimates were 100% (pT2), 97.3% (pT3a) and 90.6% (pT3b/4). Conclusions The 10‐year biochemical and clinical progression‐free survival after LRP combined with a risk‐adapted concept of adjuvant therapy is high, while prostate‐cancer specific mortality is low. Our data shows no negative impact of laparoscopic techniques on oncologic outcomes compared to large series after retropubic radical prostatectomy. In a multivariate Cox regression, only Gleason score and pT stage had significant impact on BCRFS.