Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 2000 cases

Abstract

Introduction: Review of experience with endoscopic extraperitoneal radical prostatectomy (EERPE) for localized prostate cancer.

Patients and methods: 2000 patients underwent EERPE. Mean age of the patients was 63.2 (41-77) years. Mean preoperative PSA was 10.2 ng/ml (0.64-82 ng/ml). 601 patients had undergone previous surgery. The functional and oncological outcomes were reviewed.

Results: Mean operation time was 156 (50-320) min. Complication rate according to Clavien system was: 0.45% intraoperatively, 8.6% in the early and 0.3% in the late postoperative period. Positive surgical margins were found in 127 patients with pT2 stage (9.7%) and in 237 patients with pT3 stage (34.4%). 44/937 lymphadenectomies (4.7%) had positive lymph nodes. Mean catheterization time was 6.3 days. After 12 months, 92% of the patients were completely continent, 7% needed 1-2 pads/day and 1% used more than 2 pads daily.730 patients underwent nerve sparing procedure. The 12 month potency rates with or without administration of PDE 5 inhibitors were 34.1% in the unilateral nerve sparing group and 67.7% in the bilateral group. In the intrafascial nsEERPE group, after 12 months, 93.2% of the patients were completely continent, 7.1% required 1-2 pads per day and 0.6% more than 2 pads per day. Twelve months potency rate for unilateral and bilateral nerve sparing intrafascial procedure was 33.3% and 78.5 % respectively. The rate of positive surgical margins was 6.3% in pT2 and 21.2% in pT3 specimens.

Discussion: Functional and oncological results of this large series are promising. The recently introduced intrafascial nsEERPE further improves the outcome of the procedure.