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

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

      • Incidental bladder tumour


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)


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 Gleason Score


Risk Category


Lymphnode Dissection


Nerve Sparing Prostatectomy


OP Time

  • Open RRP

    • 120 to 220 min (182 min)

  • Lap RP

    • 150 to 270 min (201 min)


OP Time


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

  • 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

  • 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

  • Overall 26/71 (36%)

  • Open

    • 7/14 (50%)

    • 6 T3a

  • Laparoscopic prostatectomy

    • 19/57 (33%)

    • 8 T3a

    • 3 T3b

    • Only one bladder neck positive


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

  • 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

Gill Riley


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