Oncological outcome of laparoscopic prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Oncology

Background:

• Laparoscopic radical prostatectomy (LRP) is a minimally invasive surgical technique for prostate cancer.
• Assessing oncological outcomes, including surgical margin status and disease recurrence, is crucial for evaluating surgical techniques.
• Biological progression-free survival (bPFS) is a key metric for long-term cancer control after treatment.

Purpose of the Study:

• To analyze oncological outcomes, specifically surgical margin status and bPFS, in patients who underwent laparoscopic prostatectomy (LRP) exclusively.
• To evaluate the impact of positive surgical margins on bPFS in different pathological T stages (pT2 and pT3).

Main Methods:

• Retrospective analysis of 136 patients who underwent LRP between April 2000 and October 2005.
• Exclusion of patients with lymph node metastasis or perioperative supportive therapy.
• Minimum follow-up of 6 months, with biological progression defined as PSA elevation >0.2 ng/mL.

Main Results:

• The overall positive margin (ew+) rate was 36.8%, with a 3-year bPFS of 72.6%.
• Positive margin rates varied significantly by pathological stage: pT2a-b (10.0%), pT2c (27.5%), pT3a (77.3%), and pT3b (53.8%).
• Three-year bPFS rates were 91.8% for pT2, 66.8% for pT3a, and 44.9% for pT3b. Positive margins had a greater negative impact on bPFS in pT3 disease compared to pT2 disease.

Conclusions:

• While 3-year bPFS rates are comparable to historical data for open prostatectomy, the high positive margin rate in pT3a disease may indicate an early learning curve effect.
• Improvements in surgical technique are needed to reduce positive margin rates, particularly at the apex.
• Positive surgical margins significantly compromise long-term oncological control in pT3 prostate cancer.