Transperitoneal versus extraperitoneal approach to laparoscopic radical prostatectomy: an assessment of 156 cases.

摘要

OBJECTIVES: To compare the results of 122 transperitoneal laparoscopic radical prostatectomy (TP-LRP) procedures with those of 34 extraperitoneal LRP (EP-LRP) procedures to assess for differences in outcomes and complications. Both TP-LRP and EP-LRP have been touted as effective techniques for performing LRP. METHODS: We retrospectively reviewed 156 LRPs performed by a single surgeon (D.M.D.) at a single institution between October 2001 and June 2003. EP-LRP was introduced in February 2003. RESULTS: The cohorts were similar in terms of mean patient age, height, weight, body mass index, and American Society of Anesthesiologists Physical Status Classification. Of the total cohort, 19 TP-LRP (16%) and 11 EP-LRP (32%) patients had clinical Stage T2; the remainder had clinical Stage T1c. Similarly, 18 TP-LRP (15%) and 9 EP-LRP (26%) patients had a biopsy Gleason grade of 7 or greater. About one third of patients underwent concomitant pelvic lymphadenectomy (all negative), and 15 TP-LRP (12%) and 2 EP-LRP (6%) patients underwent simultaneous inguinal or umbilical herniorrhaphy. Six TP-LRP patients (5%) required significant lysis of bowel adhesions. The patients in both groups had similar mean operative times (197 minutes and 191 minutes for the TP-LRP and EP-LRP group, respectively; P = 0.29). Clinically significant anastomotic leaks were documented in 7 (6%) TP-LRP and 4 (12%) EP-LRP patients (P = 0.22). The two groups had similar mean hemoglobin decreases (3.0 g/dL) and transfusion rates. The mean time of drainage and hospitalization was 0.5 day longer for the TP-LRP cohort. A mean pathologic Gleason grade of 6.3 was noted for each cohort. Twenty-one TP-LRP (17%) and eight EP-LRP (24%) specimens were pathologic Stage T3, and 29 (24%) of the former and 7 (21%) of the latter (P = 0.81) specimens were margin positive. The complication rates were similar (11% and 12% in TP-LRP and EP-LRP groups, respectively; P = 1.0), except for a greater rate of ileus in the TP-LRP cohort (3 patients). CONCLUSIONS: Extraperitoneal LRP appears to offer similar results to TP-LRP. TP-LRP was associated with a slightly greater ileus rate and EP-LRP with a slightly greater anastomotic leak rate (P = 0.22). However, the latter may have been the result of improved detection. Also, it was easier to manage using the EP-LRP approach.