Impact of previous surgery on endoscopic extraperitoneal radical prostatectomy.

摘要

OBJECTIVES: To assess the impact of previous surgery on endoscopic extraperitoneal radical prostatectomy (EERPE). METHODS: A total of 500 patients who underwent EERPE for clinically localized prostate cancer between December 2001 and April 2004 were stratified into five groups: group 1, no previous abdominal, inguinal, or prostate surgery; group 2, previous upper abdominal surgery; group 3a, previous lower abdominal or pelvic surgery or open inguinal hernioplasty; group 3b, laparoscopic or endoscopic inguinal hernioplasty; group 4, previous prostate surgery; and group 5, a combination of groups 2, 3, and/or 4. Groups 1 and 2 were analyzed together, because the previous operative fields in group 2 were distant from the space of Retzius. The operative times, complications, and reinterventions were analyzed with the Mann-Whitney U test, chi-square test, and Fisher exact test. RESULTS: Of the 500 patients, 335 (67%) and 165 (33%) were in groups 1 and 2 and groups 3 to 5, respectively. The mean overall operative time was 149 +/- 30 minutes. Four patients (0.8%) required transfusions, with no conversion to open surgery and no mortality. A total of 90 complications (18%) and nine reinterventions (1.8%) occurred. EERPE was subjectively more demanding and challenging in patients with previous minimally invasive hernioplasty with mesh placement. No statistical significance was detected between the no=surgery (groups 1 and 2) and previous surgery (groups 3 to 5) patients in terms of overall operative time, positive surgical margin status, complications, or reinterventions. CONCLUSIONS: Endoscopic extraperitoneal radical prostatectomy is feasible in patients with various previous abdominal surgical procedures. Previous surgery did not seem to affect the overall operative time or complication or reintervention rate. Previous minimally invasive hernia repair with mesh placement made EERPE more demanding but was not a contraindication.