The application and outcomes of C. R.P.C. four-step radical prostatectomy under extraperitoneal laparoscopy

Objective To summarize the preliminary experience of extraperitoneal laparoscopic radical prostatectomy (C.R.P.C. four-step) for localized prostate cancer and the outcomes based on early follow-up. Methods A total of 102 prostate cancer patients were screened by prostate specific antigen (PSA) and diagnosed by prostate magnetic resonance imaging and prostatic puncture biopsy with cT1c-cT3b, with average age of (67±5) years old, average preoperative total PSA value of (45.32±18.33) ng/ml, and average prostate volume was (42±12)cm3. All these patients underwent extraperitoneal laparoscopic radical prostatectomy by the four-step technique, abbreviating as C. R.P.C.[C: control DVC (dorsal deep venous complex). R: recognize three anatomical layers (prostate and bladder junction, seminal vesicle, and Denonvilliers’fascia surface). P: preserve urethral sphincter and bladder neck. C: continuous anastomosis between urethra and bladder neck (4 key needles at 3, 5, 7 and 9 o’clock)]. The operative time, estimated blood loss, length of hospital stay and postoperative complications were recorded, and the postoperative PSA was followed up. Results All the 102 cases were successfully treated by laparoscopic radical prostatectomy. The operative time was from 55 to 156 min (mean 92 min), and the estimated blood loss was from 55 to 185 ml (mean 105 ml). There was no case converted of open surgery, only one case received blood transfusion for postoperative hemorrhage (0.98%), and positive surgical margin was found in 15 case (14.70%) by pathological examination. Postoperative urinary extravasation within one week occurred in 2 (1.96%) cases, and resolved after tensioning the catheter and prolonging the indwelling time. During the follow-up period of 12 to 45 months, 2 cases were incontinent (grade Ⅰ-Ⅱ), and the other cases(98.04%) had no incontinence or dysuria . However, 11 cases(10.78%) developed to biochemical recurrence within 6 months after the operation. Conclusions The C. R.P.C. four-step technique of lparoscopic radical prostatectomy is easily to be grasped and performed by the greenhand urologists, and was efficient and safe. Key words: Prostatic neoplasms; Radical prostatectomy; Extraperitoneal laparoscopy; Prostate cancer; Four-step method; Curative effect