Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 2000 cases

Review of experience with endoscopic extraperitoneal radical prostatectomy (EERPE) for localized prostate cancer.

2000 patients underwent EERPE. Mean age of the patients was 63.2 (41-77) years. Mean preoperative PSA was 10.2 ng/ml (0.64-82 ng/ml). 601 patients had undergone previous surgery. The functional and oncological outcomes were reviewed.

Mean operation time was 156 (50-320) min. Complication rate according to Clavien system was: 0.45% intraoperatively, 8.6% in the early and 0.3% in the late postoperative period. Positive surgical margins were found in 127 patients with pT2 stage (9.7%) and in 237 patients with pT3 stage (34.4%). 44/937 lymphadenectomies (4.7%) had positive lymph nodes. Mean catheterization time was 6.3 days. After 12 months, 92% of the patients were completely continent, 7% needed 1-2 pads/day and 1% used more than 2 pads daily.730 patients underwent nerve sparing procedure. The 12 month potency rates with or without administration of PDE 5 inhibitors were 34.1% in the unilateral nerve sparing group and 67.7% in the bilateral group. In the intrafascial nsEERPE group, after 12 months, 93.2% of the patients were completely continent, 7.1% required 1-2 pads per day and 0.6% more than 2 pads per day. Twelve months potency rate for unilateral and bilateral nerve sparing intrafascial procedure was 33.3% and 78.5 % respectively. The rate of positive surgical margins was 6.3% in pT2 and 21.2% in pT3 specimens.

Functional and oncological results of this large series are promising. The recently introduced intrafascial nsEERPE further improves the outcome of the procedure.