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A Matched-Pair Comparison of Single Plus One Port Versus Standard Extraperitoneal Laparoscopic Radical Prostatectomy by a Single Urologist

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A Matched-Pair Comparison of Single Plus One Port Versus Standard Extraperitoneal Laparoscopic Radical Prostatectomy by a Single Urologist View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Kaohsiung Journal of Medical Sciences (2015) 31, 344e350 Available online at www.sciencedirect.com ScienceDirect journal homepage: http://www.kjms-online.com ORIGINAL ARTICLE A matched-pair comparison of single plus one port versus standard extraperitoneal laparoscopic radical prostatectomy by a single urologist Dong-Xu Zhang a, Jing-Fei Teng b, Xiu-Wu Pan c, Kai Wang d, Xin-Gang Cui c,*, Dan-Feng Xu c, Yao Li c, Yi Gao c, Lei Yin c, Jun-Kai Wang c, Lu Chen c a Department of Urologic Surgery, First Hospital of Ningbo City, Affiliated Medical School of Ningbo University, Ningbo, China b Department of Urologic Surgery, General Hospital of Beijing Military Command, Beijing, China c Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University Shanghai, Shanghai, China d Department of Urologic Surgery, Zhejiang Xiaoshan Hospital, Hangzhou, China Received 21 November 2014; accepted 9 February 2015 Available online 13 May 2015 KEYWORDS Abstract We conducted this study to report on our initial experience and assess the safety, Laparoscopic radical feasibility, and efficacy of extraperitoneal single plus one port laparoscopic radical prostatec- prostatectomy; tomy (SPOPL-RP), and determine whether it shows any objective advantage over standard Prostate cancer; laparoscopic radical prostatectomy. From June 2009 to September 2011, 15 extraperitoneal Single plus one port SPOPL-RPs were performed through a 2e3-cm subumbilical longitudinal incision and another laparoscopic radical 5-mm trocar placed at the McBurney point. This cohort was compared with 37 contemporary prostatectomy patients who underwent standard extraperitoneal laparoscopic radical prostatectomy per- formed by the same urologist. Peri- and postoperative outcomes, including continence, po- tency, and scar length, were statistically analyzed. The two groups were comparable with respect to patient demographics, estimated blood loss, drainage time, duration of catheteri- zation, catheterization rate >14 days, complication rate, postoperative hospitalization, and postoperative functional and oncologic outcomes (p > 0.05). The SPOPL-RP procedures had a longer mean operative time (170.1 minutes vs. 139.5 minutes, p Z 0.005), but with fewer patients requiring analgesics (20% vs. 54.1%, p Z 0.038) and earlier resumption of oral intake (20.7 hours vs. 26.8 hours, p Z 0.037). The mean scar length in the SPOPL-RP group was much smaller (3.4 cm vs. 5.8 cm, p Z 0.000) owing to the significant reduction of the skin incision. Conflicts of interest: All authors declare no conflicts of interest. * Corresponding author. Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Fengyang road No. 415, Huangpu District, Shanghai 200003, China. E-mail address: [email protected] (X.-G. Cui). http://dx.doi.org/10.1016/j.kjms.2015.04.006 1607-551X/Copyright ª 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved. SPOPL-RP versus standard LRP for PCa 345 The peri- and postoperative outcomes of SPOPL-RP for low-risk prostate cancer are compara- ble to those with the standard laparoscopic approach. In addition, SPOPL-RP provides better postoperative pain control, faster recovery of bowel function, and smaller scar length than standard laparoscopy, albeit with a longer operative time. Copyright ª 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved. Introduction scans showed no bone metastasis in any of the included patients. Transperitoneal and extraperitoneal laparoscopic radical Of the 96 patients, we identified 81 patients who were prostatectomy (LRP) have become the standard treatment treated with standard LRP and 15 patients who were for local prostate cancer (PCa) because of their minimal treated with SPOPL-RP for early stage local PCa. The peri- invasiveness, comparable operative duration, satisfactory operative and 24-month follow-up outcomes of the SPOPL Z pain control, short hospital stay, and quick postoperative group (n 15) were compared with the outcomes of 37 convalescence [1e3]. Given the ongoing trend toward matched patients who were treated with standard LRP minimal invasiveness in urologic surgery, single-port lapa- during the same period. Patients in the two groups were roscopy (SPL) aims to further reduce the limited invasive- matched retrospectively on the basis of patient age, body ness of conventional laparoscopy and, at the same time, mass index (BMI), American Society of Anesthesiologists offer an even better cosmetic outcome and quicker post- score, preoperative serum prostate specific antigen (PSA) operative convalescence with little pain [4]. However, SPL value, Gleason score, prostate size, preoperative conti- e remains a challenging surgical technique mainly because of nence, potency, and clinical tumor stage (cT1c cT2b). the lack of triangulation among the surgical instruments. Patients were treated with either standard LRP or SPOPL-RP Proper laparoscopic suturing techniques and considerable according to the clinical judgment of the surgeon. Criteria surgical skills are required for procedures such as radical for SPOPL-RP that could provide surgeons with the deciding prostatectomy, and proper suturing is mandatory to factors included local PCa in a relatively early stage e < adequately complete the vesicourethral anastomosis. (cT1c cT2b), preoperative serum PSA value 20, Gleason < < Meanwhile, there is a lack of sufficient scientific data to score 7 and primary Gleason score 3, relatively low BMI < confirm whether this advanced technique is objectively ( 30), and no previous abdominal surgery. Meanwhile, pa- > superior to conventional laparoscopy. tients with PCa at clinical stage T2b, distant metastasis, In this 2-year retrospective cohort, we compared single serious comorbid disease, and that have been followed up < plus one port laparoscopic radical prostatectomy (SPOPL- for 1 year were excluded. Patients were informed that RP) using the strategy of gaining multi-instrument access additional incisions or open surgical conversions might be through a single port with standard laparoscopies in an warranted during the procedure. All patients provided attempt to determine whether SPOPL had any objective informed consent. advantage over standard laparoscopies with respect to perioperative outcomes and follow-up data. Perioperative outcomes and follow-up data Patient demographics and perioperative data were reviewed, including operative time, estimated blood loss, Patients and methods transfusion rate, pre- and postoperative serum levels of hemoglobin, surgical conversions, analgesic requirement, Study design and patients time off of oral intake, scar length, drainage and cathe- terization time, pathologic results, positive surgical margin In this retrospective case-control study, we compared pa- (PSM) rate and the location of þSM, postoperative hospi- tients who underwent either SPOPL-RP or standard LRP talization length, intra- and postoperative complications beginning with our initial SPOPL-RP case in June 2009. Be- (according to the Clavien grading system [5]), pre- and tween June 2009 and September 2011, a total of 96 LRP postoperative continence and potency rate, and short- to procedures were performed by a single surgeon (Dr Danfeng intermediate-term follow-up data. PSA and correlative Xu). Patients who had received preoperative pharmaco- image examinations after RP were carried out quarterly therapy, radiotherapy preoperatively, or intraoperative during the 1st year and semiannually during the 2nd year. positive lymph node were excluded. Pre- and postoperative evaluations of continence and Indications for LRP were generally the same as those for potency were performed in 52 patients using the Interna- open prostatectomy, and patients with clinical stage tional Continence Society questionnaire and the Interna- T1ce2c PCa with a life expectancy of >10 years were tional Index of Erectile Function along with Sexual candidates for LRP. Preoperative computed tomography Encounter Profile (SEP) diaries. Potency and continence and magnetic resonance imaging examinations of the pelvic data were recorded at 3 months, 6 months, 12 months, and cavity showed no sign of metastasis, and radionuclide bone 24 months after the procedure. Patients not requiring any 346 D.-X. Zhang et al. pads or those who required one pad for safety were defined Results as continent. A requirement for two to three pads daily in patients with normal physical activity (walking) was The preoperative patient characteristics are shown in Table considered “mild incontinence”, and that for more than 1. The patient demographics were comparable between the three pads daily was deemed “incontinence”. Patients who two groups with respect to patient age, BMI, American So- responded positively to the following SEP diary questions ciety of Anesthesiologists classification, serum PSA, highest were defined as potent regardless of whether PDE-5 in- Gleason biopsy, prostate size, clinical tumor stage, preop- d hibitors were used SEP2: “Were you able to insert your erative potency, and continence. penis into your partner’s vagina?”; SEP3: “Did your erec- Surgical characteristics, pathologic outcomes, and follow- tions last long enough to have sexual intercourse?”; and up data are presented in Table 2. No surgical conversion was SEP5: “Were you satisfied with this
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