49 The factor of urinary incontinence after laparoscopic radical prostatectomy
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Laparoscopic radical prostatectomy
Salvage radical prostatectomy (SRP) has been one of the common procedures for the patients with a failure after primary treatment. We present a case of SRP with rare surgical history. To our knowledge, this is the first report of salvage surgery for residual prostate gland including prostate cancer after unsuccessful radical prostatectomy. We indicated new possibility for salvage radical prostatectomy.
Laparoscopic radical prostatectomy
Salvage Surgery
Salvage therapy
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We examined whether the prostate specific antigen (PSA) nadir is a good predictor of biochemical failure after radical prostatectomy.We retrospectively reviewed clinico-pathological data in 257 patients who underwent radical prostatectomy. Twenty-nine patients of whom PSA nadir did not reach 0.1 ng/mL and three patients in whom second line therapy was started before biochemical failure were excluded, and 225 patients were subject to this study. We evaluated the changes in PSA value at very low (from less than 0.01-0.10 ng/mL) levels using an ultra-sensitive PSA assay after radical prostatectomy. Biochemical failure was defined as three consecutive elevations of PSA to above 0.1 ng/mL.Biochemical failure-free survival was attained by 89.9% of patients at 1 year, 83.0% at 2 years, and 81.0% at 5 years. PSA nadir more than 0.01 ng/mL was strongly associated with biochemical failure after radical prostatectomy (P < 0.0001). Mean time to reach PSA nadir was 3.1 months. Preoperative PSA > 20 ng/mL (P = 0.0013), clinical T stage = T2 (P = 0.0462), Gleason score 8-10 (P = 0.0243) were also independent predictors of biochemical progression.Prostate specific antigen nadir determined by ultra-sensitive PSA assay is an important parameter that is objective, reliable, and easily measured, and useful for predicting the subgroups of patients both most likely and unlikely to exhibit biochemical progression.
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Biochemical recurrence
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The introduction of prostate-specific antigen (PSA) contributed to a shift in tumor stage at diagnosis in patients with prostate cancer. The aim of the present study was to evaluate the effects of PSA screening with low PSA cut-off values on mean total and percent-free PSA levels in patients with prostate cancers at the time of diagnosis as well as on pathologic stage and mean Gleason scores in positive biopsies and radical prostatectomy specimens.Data of 875 patients who were diagnosed with prostate cancers between 1996 and 2001 were analyzed. Patients were stratified into six groups according to the year of biopsy. Annual changes in total and percent-free PSA values, in Gleason scores of biopsies and radical prostatectomy specimens, and in pathologic stages of radical prostatectomy specimens were assessed.Mean PSA of patients diagnosed with prostate cancer decreased from 13.11 ng/ml (percent-free PSA: 11.89%) in 1996 to 7.33 ng/ml (percent-free PSA: 12.58%) in 2001 (P < 0.05). The percentage of organ-confined prostatectomy specimens increased from 64.3% in 1996 to 81.5% in 2001 (P < 0.05). However, mean Gleason scores increased from 5.23 to 6.33 over the 6 years (P < 0.05). The percentage of patients with biopsy-proven prostate cancers and PSA values below 4 ng/ml increased from 14.0% in 1996 to 39.2% in 2001. In the group with PSA values below 4 ng/ml organ-confined cancers were found in 80.0-95.2% of patients.PSAg screening with low cut-off levels has led to a significant reduction of mean baseline PSA levels in prostate cancer patients and to a significant increase in the percentage of organ-confined radical prostatectomy specimens, whereas mean Gleason scores have remained relatively constant.
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In order to assess whether the prostate-specific antigen (PSA) nadir obtained with an ultrasensitive PSA assay can be used as a prognostic indicator for patients undergoing radical prostatectomy, we investigated it retrospectively.Between October 1997 and July 2003, 46 patients underwent radical prostatectomy for prostate cancer at our institution. None of them received preoperative treatment. Levels of PSA were measured with an ultrasensitive PSA assay every 1-3 months after prostatectomy. Biochemical recurrence was defined as a PSA level of 0.2 ng/mL or higher.There was a significant difference in PSA nadir between the biochemical recurrence group and the no recurrence group (P < 0.001). The receiver operating characteristics (ROC) curve gave an optimal cut-off value for PSA nadir of 0.01 ng/mL, demonstrating a significant difference in biochemical recurrence after radical prostatectomy. No patient with a PSA nadir level <0.01 ng/mL showed biochemical failure, while 15 out of 22 patients with PSA nadir levels >or=0.01 ng/mL showed biochemical failure.The PSA nadir level obtained using an ultrasensitive PSA assay is an excellent predictor of biochemical recurrence after radical prostatectomy. Early detection of recurrence offers the possibility of early salvage therapy.
Nadir
Biochemical recurrence
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Laparoscopic radical prostatectomy
Urinary continence
Open Prostatectomy
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You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (MP74)1 Apr 2020MP74-08 OUTPATIENT EXPERIENCE WITH EXTRAPERITONEAL SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY Clark Wilson*, Juan Garisto, Alireza Aminsharifi, Guilherme Sawczyn, and Jihad Kaouk Clark Wilson*Clark Wilson* More articles by this author , Juan GaristoJuan Garisto More articles by this author , Alireza AminsharifiAlireza Aminsharifi More articles by this author , Guilherme SawczynGuilherme Sawczyn More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000960.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The da Vinci SP® surgical platform has allowed for the development of novel surgical techniques for radical prostatectomy. Robotic-assisted laparoscopic radical prostatectomy is usually followed by an overnight hospital stay. This study assesses the safety and feasibility of extraperitoneal single-port robotic radical prostatectomy as an outpatient procedure. METHODS: 60 consecutive patients with clinically localized prostate cancer underwent extraperitoneal single-port robotic radical prostatectomy by a single high-volume surgeon. Local anesthesia was used intraoperatively to infiltrate the rectus fascia as well as the skin. Minimal intraoperative fluids and in-hospital opiates were used as part of an outpatient enhanced recovery protocol. Patients were discharged the day of surgery if they were ambulatory, tolerating a regular diet and had controlled pain, regardless of surgical start time or case order. All patients were offered the option to stay overnight even if meeting these milestones. Patient data was collected prospectively in an institutional review board-approved database and evaluated retrospectively. RESULTS: All surgeries were completed in an extraperitoneal fashion with bilateral pelvic lymph node dissection. Mean operative time was 198 minutes with mean estimated blood loss of 179 mL. There were no intraoperative complications and no patients received a blood transfusion. 73% of patients were discharged on the date of surgery with a median length of stay of 4.2 hours. Final pathology revealed positive margins in 14 patients; however, 8 of these patients had pT3a disease, 5 had gleason 4+5 or 5+4 = 9 disease at final pathology and 4 of these patients were pN1. While 53% of patients were discharged with an opiate prescription, the discharge prescribing practice was changed during the series with only 10% of the last 30 patients in the series receiving opiate prescriptions at discharge. There were no emergency room visits for postoperative pain control. 7 patients had Clavien 3a complications (6 symptomatic lymphoceles requiring drainage and 1 urinoma requiring drainage). Of the patients with available 4-6 week follow up, 49% were requiring 0-1 pads per day (n=41). CONCLUSIONS: Extraperitoneal single-port robotic radical prostatectomy can be performed safely as an outpatient procedure without the need for postoperative opiates in the majority of patients. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1134-e1134 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clark Wilson* More articles by this author Juan Garisto More articles by this author Alireza Aminsharifi More articles by this author Guilherme Sawczyn More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...
Laparoscopic radical prostatectomy
Port (circuit theory)
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Objectives To compare the oncological outcomes of robot‐assisted laparoscopic radical prostatectomy with those of open radical prostatectomy in contemporary K orean prostate cancer patients. Methods From a group of 1172 patients consisting of 592 (50.5%) robot‐assisted laparoscopic radical prostatectomy and 580 (49.5%) open radical prostatectomy cases carried out between 1992 and 2008, 175 robot‐assisted laparoscopic radical prostatectomy cases were matched with an equal number of open radical prostatectomy cases by propensity scoring based on patient age, preoperative prostate‐specific antigen, biopsy G leason score and clinical tumor stage. Competing‐risks survival analyses were used to evaluate oncological outcomes, including rates of positive surgical margin, biochemical‐recurrence, adjuvant therapy, cancer‐specific survival, overall survival and metastasis‐free survival during the mean follow up of 58.4 months. Results Positive surgical margin rates were comparable between robot‐assisted laparoscopic radical prostatectomy and open radical prostatectomy cohorts (19.4% vs 21.8%), with comparable rates for all pathological stages and risk subgroups. Positive surgical margin rates according to location were comparable, with the apical margin being the most common location. Robot‐assisted laparoscopic radical prostatectomy recovered higher lymph node yields compared with open radical prostatectomy (12.5 vs 3.8; P < 0.001). The robot‐assisted laparoscopic radical prostatectomy and the open radical prostatectomy groups showed equal oncological outcomes regarding 5‐year biochemical recurrence‐free survival (log‐rank P = 0.651), metastasis‐free survival (log‐rank P = 0.876), cancer‐specific survival (log‐rank P = 0.076) and overall survival (log‐rank P = 0.648), respectively. Between groups, there was no difference in the rate of adjuvant therapy, time to first adjuvant therapy failure or in the rate of subsequent secondary treatment. Conclusions Robot‐assisted laparoscopic radical prostatectomy represents an effective surgical approach for the treatment of prostate cancer in the K orean population, as it provides equivalent oncological outcomes to open radical prostatectomy.
Laparoscopic radical prostatectomy
Biochemical recurrence
Surgical margin
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To evaluate the positive surgical margin rates and locations in radical prostatectomy among three surgical approaches, including open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy. We retrospectively reviewed clinical outcomes at our institution of 450 patients who received radical prostatectomy. Multiple surgeons were involved in the three approaches, and a single pathologist conducted the histopathological diagnoses. Positive surgical margin rates and locations among the three approaches were statistically assessed, and the risk factors of positive surgical margin were analyzed. This study included 127, 136 and 187 patients in the open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy groups, respectively. The positive surgical margin rates were 27.6% (open radical prostatectomy), 18.4% (laparoscopic radical prostatectomy) and 13.4% (robot-assisted radical prostatectomy). In propensity score-matched analyses, the positive surgical margin rate in the robot-assisted radical prostatectomy was significantly lower than that in the open radical prostatectomy, whereas there was no significant difference in the positive surgical margin rates between robot-assisted radical prostatectomy and laparoscopic radical prostatectomy. In the multivariable analysis, PSA level at diagnosis and surgical approach (open radical prostatectomy vs robot-assisted radical prostatectomy) were independent risk factors for positive surgical margin. The apex was the most common location of positive surgical margin in the open radical prostatectomy and laparoscopic radical prostatectomy groups, whereas the bladder neck was the most common location in the robot-assisted radical prostatectomy group. The significant difference of positive surgical margin locations continued after the propensity score adjustment. Robot-assisted radical prostatectomy may potentially achieve the lowest positive surgical margin rate among three surgical approaches. The bladder neck was the most common location of positive surgical margin in robot-assisted radical prostatectomy and apex in open radical prostatectomy and laparoscopic radical prostatectomy. Although robot-assisted radical prostatectomy may contribute to the reduction of positive surgical margin, dissection of the bladder neck requires careful attention to avoid positive surgical margins.
Surgical margin
Laparoscopic radical prostatectomy
Margin (machine learning)
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Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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Laparoscopic radical prostatectomy
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