[Celioscopic lymphatic excision and perineal radical prostatectomy: a strategy for the treatment of prostatic cancer]

Radical perineal prostatectomy despite its many advantages over the past decade had decreased in popularity compared with the retropubic approach and was limited to a few specific indications. The primary reason for this trend was in the ability to first evaluate pelvic lymph node metastases by frozen section using only one retropubic incision. Recently our institution has developed an alternative method which combines laparoscopic lymph node dissection (LLND) with radical perineal prostatectomies (RPP). From January 1990 to January 1992, 30 patients with a mean age of 64 were identified as having clinical stage B prostatic carcinoma. From this population a total of 36 procedures were performed by the senior author. 9 patients underwent LLND alone (group 1), 13 patients underwent RPP alone (group 2) and 14 patients underwent combination LLND and RPP (group 3). The mean EBL for groups 1, 2 and 3 were 1.2, 5 and 5.6 days respectively. Number of transfusions for patients requiring blood in groups 2 and 3 were 1.2 units and 1.5 units respectively. There were no significant differences in post-operative stay, post-operative complications, day tolerating diet or days of analgesia despite the difference in operating room and anesthesia time: group 2 (2:25) and group 3 (5:29). All levels of PSA in groups 2 and 3 remain trace at 1, 3, 6 and 12 months post operatively except for one patient.(ABSTRACT TRUNCATED AT 250 WORDS)