Laparoscopic Extraperitoneal Radical Prostatectomy in Complex Surgical Cases

摘要

No AccessJournal of UrologyAdult urology1 May 2007Laparoscopic Extraperitoneal Radical Prostatectomy in Complex Surgical Cases Alejandro R. Rodriguez, Rachna Kapoor, and Julio M. Pow-Sang Alejandro R. RodriguezAlejandro R. Rodriguez Department of Interdisciplinary Oncology, Division of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida , Rachna KapoorRachna Kapoor Division of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida , and Julio M. Pow-SangJulio M. Pow-Sang Department of Interdisciplinary Oncology, Division of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida View All Author Informationhttps://doi.org/10.1016/j.juro.2007.01.034AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Patients with a high body mass index, previous pelvic surgery or large prostate size are not considered ideal candidates for radical prostatectomy. We assessed the impact of body mass index, previous pelvic surgery and prostate weight on perioperative and pathological outcomes in patients treated exclusively with laparoscopic extraperitoneal radical prostatectomy. Materials and Methods: From January 2004 to May 2005, 300 patients underwent laparoscopic extraperitoneal radical prostatectomy. Patients were divided into groups, including body mass index groups 1 (25 kg/m2 or less), 2 (25.1 to 30), 3 (30.1 to 36) and 4 (greater than 36); prostate weight groups 1 (20 gm or less), 2 (20.1 to 40), 3 (40.1 to 60) and 4 (more than 60); and prior surgery groups 1 (no previous pelvic or prostatic surgery) and 2 (previous pelvic or prostatic surgery). Results: Logistic regression demonstrated that body mass index, large prostate size and previous pelvic surgery did not affect margin status. The Kruskal-Wallis test was performed to analyze if body mass index, large prostate size and previous pelvic surgery had an effect on perioperative variables. Only prostate weight correlated with a delay in Foley catheter removal (3 days, p = 0.0005). The Wilcoxon rank sum test showed that patients with a higher body mass index had a slightly prolonged hospital stay (16 hours, p = 0.02). Patients with a prostate of more than 40 gm had slightly increased blood loss (56 cc, p = 0.03), which did not affect the transfusion rate. Conclusions: Laparoscopic extraperitoneal radical prostatectomy can be performed in complex surgical cases without increased perioperative morbidity. Obese patients and those with a large prostate who prefer surgery as a treatment option for localized prostate cancer may benefit from the advantages that laparoscopic extraperitoneal radical prostatectomy offers. References 1 : Laparoscopic radical prostatectomy: a multi-institutional study of conversion to open surgery. Urology2004; 63:: 99. Google Scholar 2 : Laparoscopic radical prostatectomy—an analysis of factors affecting operating time. Urology2003; 62: 314. Google Scholar 3 : Impact of obesity on clinical outcomes in robotic prostatectomy. Urology2005; 65: 740. Google Scholar 4 : Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology2006; 67: 774. Google Scholar 5 : Impact of prostate size and body mass index on perioperative morbidity after laparoscopic radical prostatectomy. J Urol2005; 173: 552. Link, Google Scholar 6 : Laparoscopic radical prostatectomy and body mass index: an assessment of 151 sequential cases. J Urol2005; 173: 442. Link, Google Scholar 7 : The effect of previous transperitoneal laparoscopic inguinal herniorrhaphy on transperitoneal laparoscopic radical prostatectomy. J Urol2005; 173: 769. Link, Google Scholar 8 : The impact of prostate size in laparoscopic radical prostatectomy. Eur Urol2005; 48: 285. Google Scholar 9 : Impact of previous surgery on e