Radical Prostatectomy Sept 2009 till Aug 2010

South Mersey Cancer Network

Manal KumarConsultant 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 categoriesPrevious 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