Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 1,300 cases

We herein review our experience with endoscopic extraperitoneal radical prostatectomy (EERPE) as a first line therapy for localized prostate cancer. A series of 1,300 patients underwent EERPE ("wide excision", standard nervesparing technique (nsEERPE), or intrafascial nsEERPE). The mean age of the patients was 63.3 years. Preoperative PSA mean value was 10.1 ng/ml. A total of 415 patients had undergone previous surgical procedure in the lower abdomen (n = 336) and prior surgery of the prostate (n = 79), respectively. The EERPE was employed in all cases without any specific selection criteria. Mean operative time was 153 (50-320) min. including lymphadenectomy with no conversion to open surgery. Seven intraoperative, 91 early and 4 late complications occurred. The transfusion rate was 0.9%. Positive surgical margins were found in 83 patients with pT2 stage (9.8%) and in 154 patients in pT3 stage (34.3%). The mean catheterization time was 6.2 days. The 12 month follow up indicated continence rate of 91.9% and potency rates of 34% in the unilateral nerve sparing group and 69.8% in the bilateral group. In the intrafascial nsEERPE group potency rates were 33.3% (unilateral) and 79.1% (bilateral) after 12 months. Postoperative positive surgical margins rate were 6.1% for pT2 and 20% for pT3 and the complications rate 4%. The results of this large series of 1,300 patients are promising. The recently introduced intrafascial nsEERPE further ameliorates the outcome of the procedure.