Radical prostatectomy sept 2009 till aug 2010
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Radical Prostatectomy Sept 2009 till Aug 2010. South Mersey Cancer Network Manal Kumar Consultant Urologist. Radical Prostatectomy. 80 patients 17 open (1/16) 42 to 73 yrs (63 yrs) 63 laparoscopic 44 to 74 yrs (63 yrs) Two patients did not undergo lap prostatectomy Extensive adhesions

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Radical Prostatectomy Sept 2009 till Aug 2010

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Radical prostatectomy sept 2009 till aug 2010

Radical Prostatectomy Sept 2009 till Aug 2010

South Mersey Cancer Network

Manal Kumar

Consultant Urologist


Radical prostatectomy

Radical Prostatectomy

  • 80 patients

  • 17 open (1/16)

    • 42 to 73 yrs (63 yrs)

  • 63 laparoscopic

    • 44 to 74 yrs (63 yrs)

    • Two patients did not undergo lap prostatectomy

      • Extensive adhesions

      • Incidental bladder tumour


Pre op psa

Pre op PSA

  • Open

    • 4.2 to 18.8ng/ml(9.5ng/ml)

  • Lap RP

    • 0.8 to 29.7 ng/ml (8.5ng/ml)


Radical prostatectomy sept 2009 till aug 2010

Patient Selection

  • All risk categories

  • Previous operations

    • TURPs,

    • inguinal and para-umbilical hernia

    • appendicectomy

  • BMI up to 38

  • Prostate volume

    • 18 to 150 cc


Pre op staging

Pre op Staging


Pre op gleason score

Pre op Gleason Score


Risk category

Risk Category


Radical prostatectomy sept 2009 till aug 2010

Lymphnode Dissection


Radical prostatectomy sept 2009 till aug 2010

Nerve Sparing Prostatectomy


Op time

OP Time

  • Open RRP

    • 120 to 220 min (182 min)

  • Lap RP

    • 150 to 270 min (201 min)


Radical prostatectomy sept 2009 till aug 2010

OP Time


Blood loss

Blood Loss

  • Open RRP

    • 500 ml to 3000 ml (1400ml)

    • Data was not recorded for 10 patients

    • One patient had blood transfusion

  • Lap RP

    • 50 to 1000 ml (265 ml)

    • No blood transfusion


Laparoscopic prostatectomy complications

Laparoscopic Prostatectomy Complications

  • One (1.6%) incisional hernia (Clavien 3b)

  • One (1.6%) lymphocele (Clavien 3a)

  • One (1.6%) peno- bulbar stricture (Clavien 3a)

  • One blocked catheter (Clavien 1)

  • One patient had mild haematuria (Clavien 1)

  • No transfusion, no ileus and no conversion to open surgery

  • No anastamotic strictures


Length of stay

Length of Stay

  • Open prostatectomy

    • 3 to 8 days (5.9 days)

  • Lap prostates

    • 2-6 days (2.3 days)

    • All except two patients were discharged within 3 days


Positive surgical margins

Positive Surgical Margins

  • Overall 26/71 (36%)

  • Open

    • 7/14 (50%)

    • 6 T3a

  • Laparoscopic prostatectomy

    • 19/57 (33%)

    • 8 T3a

    • 3 T3b

    • Only one bladder neck positive


Radical prostatectomy sept 2009 till aug 2010

Post Operative PSA

  • PSA <0.1ng/ml94%

  • Only 4 (6%) of LRP patients have PSA above 0.1%

  • Two of these patients had T3b disease and three of the four have Gleason 4+4 disease

  • 13/14 (92%) open prostatectomy patients had PSA <0.1 ng/ml


Continence

Continence

  • 50 patients with > 3 mths follow up

  • Four (8%) wearing more than one pad a day

  • 2/12 open prostatectomy patients wearing more than one pad a day


Acknowledgement

Acknowledgement

Gill Riley


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