Search PubMed⌕ Search

Biomedical subjects

Bertrand Guillonneau

Publications and source records attributed to Bertrand Guillonneau.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic radical prostatectomy: a critical analysis of surgical quality.

OBJECTIVE: To review the literature and answer the question of whether the laparoscopic approach meets the quality standards. METHODS: We conducted an extensive Medline literature search. The articles obtained and the experience at Memorial Sloan-Kettering Cancer Center were used for interpretation and critical analysis of results. Long-term quality indicators are oncologic efficacy, potency rate, and continence rate. Short-term quality indicators are blood loss and transfusion rate, hospital stay, postoperative recovery, and rate and severity of complications. RESULTS: Long-term quality indicators. Oncologic efficacy. Despite recent evidence that pelvic lymph node dissection (PLND) at radical prostatectomy may be necessary to detect occult positive lymph nodes, and that extended node dissection may also have a positive impact on disease-free survival, PLND is rarely performed during laparoscopic radical prostatectomy (LRP), which may have a negative impact on the long-term recurrence-free probability. Positive margins rates range from 11% to 26%, ranging from 6% to 8% for organ-confined disease and from 35% to 60% in those with extraprostatic extension. Most of these data include the first patients operated on when the technique of LRP was in early development. These rates seem high as compared to the contemporary data achieved in retropubic radical prostatectomy. Short-term biochemical recurrence rate have been published by only two centers and generalization to the whole laparoscopic patients and to long-term results are at present time hazardous. Functional outcome. Given the complexity of measuring, interpreting, and reporting continence and erectile dysfunction, the available results after LRP do not allow drawing any conclusion. Furthermore, the number of patients on whom results are reported is disproportionately low in relation to the large LRP experience accumulated so far. Short-term quality indicators. Assessment of LRP equanimity includes factors such as blood loss, transfusion rates, hospital stay, duration of catheterization, and complication profile. All the reports are concordant and demonstrate a benefit for the laparoscopic approach. However, no prospective and parallel studies compare the respective advantages of LRP and radical retropubic prostatectomy in reference centers. CONCLUSIONS: In a review of the published literature results of LRP, there is not enough evidence to answer the question of whether the laparoscopic approach meets the quality standards. The available biochemical recurrence information is promising but limited to the short-term and the experience of two centers only. The question of omitting the PLND or performing a limited one in high-risk patients needs to be answered. The functional results analyses suffer from a lack of uniformity in methodology, a limited follow-up, and a disproportionately small number of patients in relation to the accumulated experience. Future reports of the post-learning phase era are dramatically needed.

Humans↗
PubMed2006

Impact of a multidisciplinary continuous quality improvement program on the positive surgical margin rate after laparoscopic radical prostatectomy.

OBJECTIVE: Outcome after radical prostatectomy is highly sensitive to fine nuances in the surgical techniques. We sought to determine the impact of a process of continuous control and monitoring on the positive surgical margin rate in a contemporary series of laparoscopic radical prostatectomy. METHODS: Between January 2003 and October 2004, 301 men underwent laparoscopic radical prostatectomy for clinically localized prostate cancer (cT1-cT3a). A weekly case review conference involving surgeons, radiologists, and uropathologists was held to discuss the preoperative, intraoperative, and pathologic findings of significant cases. We analyzed the trend of positive surgical margins and compared the clinical and detailed pathologic characteristics of the cancer during the study period. RESULTS: We created logistic regression models with positive margin as the dependent variable and surgical experience as the predictor, adjusting for possible secular changes in disease severity (prostate-specific antigen, pathologic stage, and Gleason grade). There was a decrease in the rate of surgical margins: odds ratio 0.68/100 patients treated (95% confidence interval [CI] 0.44, 1.05; p=0.08). The predicted probability for a positive surgical margin falls from 17.3% for the first patient to 7.5% for the 301st. These values are close to the observed rates for the first and last 50 patients. There was no important change in surgical risk over the course of the study, and the rate of nerve sparing remained stable throughout the study period. CONCLUSIONS: In this contemporary series, which is unaffected by downward stage migration, the decreasing rate of positive surgical margins can be explained by subtle surgical technique modifications and a continuous multidepartmental effort for quality improvement.

Biopsy↗
PubMed2005

Positive surgical margins and accessory pudendal artery preservation during laparoscopic radical prostatectomy.

PURPOSE: To determine whether preservation of accessory pudendal arteries (APAs) adversely influences the rate of positive surgical margins (PSMs) during laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS: Between January 2003 and January 2005, 377 men with clinically localized prostate cancer underwent a LRP; 325 met inclusion criteria for this study. The variety (apical or lateral), laterality (left or right), size, and preservation status of all identified APAs were prospectively recorded. A genitourinary pathologist mapped the specimens and established tumor locations and PSM sites. RESULTS: Ninety-six of 325 men (30%) were found to have 125 separate APAs. The apical variety predominated; 56% of APAs were apical and 44% were lateral. Successful preservation was possible for 104/125 (83%) individual arteries. The overall rate of PSM was 11.7%. The rates for those with and without identified APAs were 9% and 13%, respectively (p=0.4). The incidence of PSMs in the ipsilateral region of APA localization was not affected by preservation status; ipsilateral PSM rates were 3% and 6% for those preserved and not preserved, respectively (p=0.5). CONCLUSIONS: Identification and preservation of APAs during laparoscopic radical prostatectomy did not adversely affect the rates of PSMs. APA preservation can be undertaken without compromise to the oncological integrity of the laparoscopic radical prostatectomy.

Arteries↗
PubMed2005

The importance of MRI evaluation in the preoperative work-up of prostate cancer.

BACKGROUND: A 59-year-old man on exogenous androgen therapy presented with a clinically palpable prostate nodule confined to one lobe on endorectal examination. Serum prostate-specific antigen was 3.4 ng/ml. Bone scintigraphy and baseline CT were reportedly negative. INVESTIGATIONS: Physical examination, laboratory evaluation, endorectal MRI of the prostate, cystoscopy and biopsy. DIAGNOSIS: Poorly differentiated adenocarcinoma of the prostate, with invasion of the urinary bladder. MANAGEMENT: Neoadjuvant hormonal therapy, followed by radiation.

Adenocarcinoma↗
PubMed2005

Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin.

PURPOSE: We correlated intraoperative video documentation and pathology findings to understand the mechanisms by which positive surgical margins occur and improve the surgical technique. MATERIALS AND METHODS: Between January 2003 and May 2004, 240 consecutive patients underwent laparoscopic radical prostatectomy, of whom 180 had pT2 prostate cancer and represent the population of this study. After the first 90 patients (group 1) we started a quality assurance study, analyzing intraoperative video recordings and correlating them with pathology findings in patients with a positive margin. The cancer characteristics and positive margin rate were compared between the first 90 patients and the subsequent 90 after the study was initiated (group 2). RESULTS: Of the 12 cases of positive surgical margins studied the video review helped identify 8 with a technical error. In all 4 cases in which a technical error could not be identified the positive margin site was at the distal apex. The most frequent identifiable mechanism by which positive margins occurred was a capsular tear during neurovascular bundle dissection. The 2 groups were comparable in regard to preoperative cancer characteristics and total tumor volume. In patients who underwent bilateral nerve sparing the positive margin rate was 10.6% in group 1 and 5.4% in group 2 (p = 0.18). All positive margins in group 2 involved the prostatic apex. CONCLUSIONS: Quality assurance efforts through pathological and intraoperative documentation review can help decrease the positive margin rate, particularly in organ confined disease. However, eradicating positive margins at the distal prostatic apex remains a challenge.

Humans↗
PubMed2005

Laparoscopic radical prostatectomy.

PURPOSE: After the pioneering period when only few teams were performing the procedure, the laparoscopic approach to radical prostatectomy has become widespread with several technical variations. A comprehensive review of the published literature on laparoscopic radical prostatectomy was performed to determine the current state of the art of this surgical innovation in terms of perioperative parameters, functional results and cancer control. MATERIALS AND METHODS: English language, peer reviewed articles published before June 2004 concerning laparoscopic radical prostatectomy were found by MEDLINE query. All articles were analyzed and none were a priori excluded. Conclusions were drawn from series of 50 or more patients. RESULTS: Laparoscopic radical prostatectomy is being performed at multiple centers worldwide using various surgical approaches and technologies. Analysis of perioperative parameters, including surgical blood loss, operative time, complications and convalescence, demonstrated low morbidity and showed a clear trend toward improvement with increased experience. The reported positive surgical margin rates were lower in more recent series. As measured by prostate specific antigen recurrence and disease-free intervals, oncological results and cancer control rates are difficult to ascertain in the immature series published to date. Functional results in terms of postoperative urinary and sexual function appear encouraging. CONCLUSIONS: Overall the current operative, oncological and functional results of laparoscopic radical prostatectomy appear to approximate those of open radical retropubic prostatectomy. These results justify the considerable interest of the urological community in laparoscopy, as evidenced by its widespread application. Nevertheless, longer followup and more mature data are needed definitively to establish laparoscopic radical prostatectomy as an alternative to the retropubic approach.

Disease-Free Survival↗
PubMed2005

Anatomy of accessory pudendal arteries in laparoscopic radical prostatectomy.

PURPOSE: The incidence of accessory pudendal arteries (APAs) varies from 4% to 70% depending on the means used to identify them. We provide a detailed laparoscopic anatomical description of their appearance, location and identification rate based on our series of radical prostatectomies. MATERIALS AND METHODS: The distribution of APAs was prospectively recorded in 285 consecutive patients between October 2002 and November 2004. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex and extending caudal toward the anterior perineum, other than cavernous arteries, corona mortis and satellite arteries to the superficial and deep vascular complex. RESULTS: We identified 92 APAs in 72 of 285 patients (25%). Two distinct varieties of APAs were identified. In 10% of patients an APA coursed along the lateral aspect of the prostate, termed lateral APA, and in 13% an APA emerged through the levator ani fibers near the apical region of the prostate, termed apical APA. Five patients (1.7%) were found to have apical and lateral APAs. CONCLUSIONS: APAs are more frequent than previously reported in the surgical literature. To our knowledge apical APAs have never been reported previously. The visualization and accessibility advantages of laparoscopy may account for a higher intraoperative APA identification rate. Their roles in continence and potency remain to be determined.

Arteries↗
PubMed2004

Advances in laparoscopic partial nephrectomy.

PURPOSE OF REVIEW: The advantages of the laparoscopic approach in the management of kidney tumors are unequivocal and the role of laparoscopy in nephron-sparing surgery is evolving. In a selected group of patients with small exophytic renal tumors laparoscopic partial nephrectomy became an alternative to open partial nephrectomy. However, the application of laparoscopic partial nephrectomy to larger, centrally located tumors or tumors in unfavorable sites is limited by the difficulty of achieving adequate, prompt collecting system closure and hemostasis with a limited warm ischemia time. The most recent developments in laparoscopic partial nephrectomy are the subject of this review. RECENT FINDINGS: A number of sealant products have been used as an adjunct or principal hemostatic agent in the animal model. Their application in the clinical setting remains limited to small parenchymal bleeding; larger vessels and pelvicaliceal openings are better managed by vascular clamping and intracorporeal suturing. Vascular clamping confers warm ischemia, and attempts at renal hypothermia included cold kidney irrigation through either a ureteral stent or a renal artery cannulation, and the application of ice slush for parenchymal surface cooling. SUMMARY: Laparoscopic partial nephrectomy is technically demanding; efforts directed towards facilitating hemostasis, improving renal cooling or shortening the warm ischemia time will expand its indications further.

Humans↗
PubMed2003

Robotically assisted laparoscopic dismembered pyeloplasty: a chronic porcine study.

OBJECTIVES: To evaluate the feasibility and efficacy of robotically assisted laparoscopic dismembered pyeloplasty in an animal model. We also investigated whether the use of a device that lacks tactile feedback results in tissue damage and subsequent stenosis or leaking of the anastomosis. METHODS: Robotically assisted dismembered pyeloplasty was performed on 10 farm pigs. After 1 month, all pigs were anesthetized again for intravenous urography and to remove the kidney and ureter on the operated side. Histopathologic examination of all specimens was performed. RESULTS: All animals survived the initial procedure without complications. In the first five procedures, the time required for the performance of the anastomosis showed a decreasing trend. In the last five procedures, 30 to 40 minutes were required for the anastomosis. The results of urography showed mild hydronephrosis in 1 case (animal 7). The other animals showed no abnormalities. The histopathologic examination of the specimen showed a large foreign body granuloma in the ureteral wall of animal 7 that caused the before-mentioned obstruction. No significant abnormalities were seen in the other animals. CONCLUSIONS: Robotically assisted laparoscopic dismembered pyeloplasty is a technically feasible procedure with an acceptable morbidity in an animal model. No significant histologic effects were seen of the possibly less-delicate tissue handling by the robotic device. The benefit of this technological progress has not yet been established. Therefore, the use of these techniques has to be thoroughly assessed before their clinical application.

Animals↗
PubMed2003

An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy.

OBJECTIVE: To provide a detailed description of the steps involved in a laparoscopic radical prostatectomy in relation to the complex neurovascular anatomy of the male pelvis. AIM AND HYPOTHESIS: We aimed at delineating the neurovascular anatomy to assist in nerve preservation during laparoscopic and robotic radical prostatectomies. METHODS: A team of urologists and an anatomist performed anatomic dissections of 12 male cadavers using a combination of laparoscopic equipment, magnification, and open surgical dissection. Each step involved in laparoscopic prostatectomy was reviewed in relation to the possible impact the step could have on the neurovascular bundles. RESULTS: Dissections were performed systematically to mimic various steps of laparoscopic and robotic prostatectomy. The neurovascular bundles were identified and correlated with video images of actual surgery. This enabled us to construct computer simulations and show the actual nerves on the operative pictures. We specially unraveled the relationship between neurovascular bundles and lateral pelvic and Denonvillier's fascias, both of which enclose and hide these important structures. The course of the bundles was traced from its origin at pelvic plexus to its distal course along the urethra. We also showed the important relationship between pelvic plexus ganglions and seminal vesicles to illustrate the vulnerability of these nerves to thermal, electrical and/or crush injury during seminal vesicle and prostatic pedicle dissections. The importance of additional fine neural plexus along the posterior and antero-lateral surface of the prostate was shown by both gross anatomical and microscopic images. The distal precarious location of the bundles was illustrated by dissections showing anteriorly lifted prostate.These anatomico-operative correlations have not been published for laparoscopic and robotic prostatectomies, which differ significantly in its visual angles, magnifications and sometimes three-dimensional (3D) visualization from its open counter part. CONCLUSION: Laparoscopic and robotic radical prostatectomy provides exposure and visualization of male pelvis not previously appreciated. It is only through a careful reexamination of the anatomy of the male pelvis, in the context of this new procedure, that the improvements in visualization and exposure benefit the surgeon. Our work provides a detailed map relating to operative steps to aid the surgeon in the performance of a nerve sparing robotic and laparoscopic radical prostatectomy.

Fascia↗
PubMed2003

In vitro training program to improve ambidextrous skill and reduce physical fatigue during laparoscopic surgery: preliminary experience.

PURPOSE: We illustrate the preliminary experience with our planned intensive in vitro training program focused on the nondominant hand and reducing physical fatigue. Apart from this, we tried to calculate how much training is required for a novice urologist to master laparoscopic freehand suturing with the dominant and nondominant hands. MATERIALS AND METHODS: Between December 2001 and May 2002, one trainee worked on a Pelvi-trainer, first with the dominant (right) hand and then with the left hand, practicing intracorporeal suturing and cutting and improving physical endurance by gradually increasing the duration of each training session. Along with the Pelvi-trainer, he worked on left-handed writing to improve wrist movements. Before starting this training, he did not have any laparoscopic experience as assistant or primary surgeon. The progress was stored in the computer prospectively to compare the results with those obtained at the end of the training. RESULTS: For the dominant hand, 30 hours over 2 months was required to master laparoscopic suturing skills. After training of the right hand, the nondominant hand required 40 hours of Pelvi-trainer work and 20 hours of handwriting during 2 months. Physical endurance for suturing in the Pelvi-trainer increased from 15 minutes to 150 minutes over 3 months. The main improvement was in the degree of pain over the right shoulder (because of the abducted position) and backache. CONCLUSION: Incorporation of sufficient in vitro training to improve nondominant hand functioning and reduce physical fatigue can make adaptation to laparoscopic surgery easier.

Clinical Competence↗
PubMed2003

Initial experience in laparoscopic partial nephrectomy for renal tumor with clamping of renal vessels.

PURPOSE: To describe our initial experience with laparoscopic partial nephrectomy (LPN) with clamping of the renal vessels before tumor excision and suturing of the renal parenchyma. PATIENTS AND METHODS: Between July 2001 and April 2002, 19 consecutive patients underwent transperitoneal LPN in our institution, 14 for tumors <4 cm with suspicion of renal-cell cancer and 5 for suspicion of angiomyolipoma at CT with one tumor confirmed histopathologically by percutaneous needle biopsy. We divided these patients into the first 10 cases (Group 1) and the last 9 cases (Group 2). One patient had end-stage renal disease but was not on dialysis; the remaining patients had elective partial nephrectomy. Initially, a ureteral catheter was placed. The partial nephrectomy was performed with clamping of the renal vessels, so that the tumor was excised with cold scissors. Intracorporeal cooling of the kidney was achieved by a ureteral catheter connected to a 4 degrees C solution flowing to the renal pelvis during the whole procedure until the clamps were released. Intracorporeal free-hand suturing was exclusively used to close the collecting system (when opened) and to approximate the renal parenchyma. RESULTS: All procedures were completed laparoscopically. The mean renal warm ischemia time was 28.5+/-7 minutes (range 15-47 minutes). The mean laparoscopic operating time was 125+/-37 minutes (range 90-390 minutes). The mean intraoperative blood loss was 290+/-276 mL (range 25-1200 mL). Two patients required blood transfusion, and four had complications. There was immediate deterioration in renal function (creatinine 1.42+/-0.56 mg/dL), but improvement was seen at 1 month (1.17+/-0.34 mg/dL). There were no statistically significant differences in operative features and outcomes in Groups 1 and 2, but there were improvements in the mean operating time by 30 minutes, the mean intraoperative blood loss by 113 mL without any transfusion, and the mean renal warm ischemia time by 6 minutes. There was only one patient in Group 2 with a complication. The surgical margin was negative for tumor for all patients. Postoperative pathology examination showed renal-cell cancer in 11 patients (pT1), oncocytoma in 3 patients, and angiomyolipoma in 5 patients. The mean tumor grade was 2. The mean tumor size was 25.8+/-11.6 mm with a mean tumor-free margin of 2.6+/-2.4 mm. The median follow-up is 3 months, so oncologic outcome cannot be assessed. CONCLUSION: The technique of LPN can be standardized and should be proposed for small tumors when they are not invading the hilum. Clamping the renal pedicle allows better vision for more accurate tumor excision with a safety margin and hemostatic suturing of the parenchymal defect, resulting in less blood loss and shorter operative time, parameters that improve with experience.

Adenoma, Oxyphilic↗
PubMed2003

DNA adducts in normal bladder tissue and bladder cancer risk.

Cigarette smoking is an established cause of bladder cancer. The direct relationship between smoking-induced DNA adducts in bladder cells and cancer risk at that site has, however, been poorly assessed. We therefore investigated the relationship between bladder cancer risk and levels of DNA adducts measured in normal bladder biopsies by 32P-post-labeling in a hospital-based case-control study of 59 bladder cancer patients and 45 controls submitted to surgery for prostatic hyperplasia or urinary incontinence. An approximately 2-fold risk for bladder cancer was found in individuals with an adduct level >14.8 (median among controls) compared with those with an adduct level < or =14.8 (OR = 1.9, 95% CI 0.8-4.3, P = 0.13). A dose-response relationship was also suggested (trend test, P = 0.13): compared with adduct levels below 13.5, the OR for bladder cancer was 1.7 (95% CI 0.6-4.6) for adduct levels between 13.5 and 18.5 and 2.2 (95% CI 0.8-6.1) for adduct levels >18.5. These findings provide some evidence that DNA adducts in bladder tissue might predict smoking-induced bladder cancer. Larger studies are still warranted to confirm these results.

Aged↗
PubMed2003

Allelic losses in localized prostate cancer: association with prognostic factors.

PURPOSE: Loss of heterozygosity (LOH) is the most consistent genetic alteration in prostate cancer (CaP), frequently associated with advanced cancer and metastasis. We performed LOH analysis on 6 chromosomal regions of interest in localized CaP to obtain an overview of allelic losses in organ confined tumors and test the association with the usual prognostic factors. MATERIALS AND METHODS: Tumoral and normal DNA were extracted from 48 radical prostatectomy specimens (all organ confined) with a Gleason score of 5 to 7. Biological and pathological data, such as prostate specific antigen (PSA), Gleason score and perineural invasion (PNI), were correlated with allelic losses at 7q31, 8p22, 12p13, 13q14, 16q23.2 and 18q21. Analysis was done by genotyping using highly informative microsatellites markers. RESULTS: The rate of LOH was 25% for chromosomes 13 and 18, and between 40% and 47% for chromosomes 7, 8, 12 and 16. The mean frequency of overall LOH events was less than 34%. Except for the 12p13 and 16q23.2 loci no significant correlation was found between LOH and PSA or Gleason score. PNI was significantly associated with LOH on 8p22 (p = 0.003) and with a high frequency of LOH events (greater than 34%) (p = 0.02). CONCLUSIONS: The frequency of allelic losses in localized and differentiated CaP is associated with PNI but not with the usual prognostic markers, such as PSA and Gleason score. The relationship between LOH on 8p22 and PNI suggests the presence on this region of a gene involved in epithelium/nerve interaction.

Humans↗
PubMed2002

Cystectomy with prostate sparing for bladder cancer in 100 patients: 10-year experience.

PURPOSE: To minimize the risk of incontinence and impotence without compromising oncological outcome, we performed prostate sparing surgery during radical cystectomy for bladder cancer. MATERIALS AND METHODS: Since 1992, 100 patients with a mean age of 64 years (range 48 to 82) underwent cystectomy for bladder transitional cell carcinoma with prostate sparing based on normal digital rectal examination of the prostate, normal prostate specific antigen (PSA), percent free PSA greater than 15 and normal transrectal ultrasound of the prostate. Prostate biopsies to exclude prostate cancer were performed on patients with an abnormal digital rectal examination, high PSA, percent free PSA less than 15 or hypoechoic lesions on ultrasound. Surgery consisted of transurethral resection of the prostate with analysis of frozen section of the prostatic urethra and transitional prostate and cystectomy with reconstruction by a Z ileal bladder anastomosed to the prostatic capsule after confirmation of the absence of prostate or bladder cancer on frozen sections of the surgical capsule specimens. Patients were followed closely with imaging and laboratory studies every 6 months and annually for 3 years thereafter. RESULTS: Perioperative death occurred in 1 patient due to septicemia, 20 patients (20%) died of cancer and 6 (6%) died of nonrelated cancer causes. Mean followup 38 months (range 2 to 111). Postoperative pathological stage was PT0 in 2 cases, PtaT1 in 22, PT2 in 48, PT 3 in 28 and N+ in 13. The 5-year actuarial global survival according to pathological stage was pTaT1N0 in 96% of cases, pT2N0 in 83%, pT3N0 in 71% and N+ in 54% (p = 0.0001). The 5-year actuarial cancer specific survival was PT0, Ta T1 in 90% of cases, PT2 in 73%, PT3 in 63% and N- in 8%. The cancer specific survival according to pathological grade was 100% for well differentiated tumors (grade I), 76% for moderately differentiated tumors (grade II) and 47% for poorly differentiated tumors (grade III) (p = 0.003). Local recurrence was pTaT1N0 in 1 of 22 cases (4.5%), pT2N0 in 2 of 40 (5%), pT3N0 in 2 of 23 (8.5%) and N+ in 0 of 13 (0%). Prostate cancer was diagnosed in 3 patients (2 errors in the diagnosis and 1 cancer de novo within 5 years of followup). At 1-year followup 86 of 88 patients (97%) are fully continent (no pad) during the day, and 84 (95%) void 1 to 2 times a night to stay dry. Of 61 patients with previously adequate sexual function 50 (82%) maintained potency with retrograde ejaculation secondary to transurethral resection, 6 (10%) have partial potency and 5 (8.1%) are impotent. CONCLUSIONS: Cystectomy with prostate sparing for bladder cancer is feasible and offers promising functional results with no additional oncological risk. Careful selection of patients is mandatory.

Aged↗
PubMed2002

Laparoscopic radical prostatectomy. preliminary pathologic evaluation.

OBJECTIVES: Although there is increasing evidence of the interest in the laparoscopic approach for radical prostatectomy, carcinologic data, including surgical margin status, remain to be described. METHODS: We analyzed the oncologic results of laparoscopic prostatectomies performed during 2000. The data were compared with retropubic prostatectomies performed between 1994 and 1997 by the same two senior urologists. After matching for preoperative prostate-specific antigen level, the final analysis included 139 patients in both groups, with similar data for age, biopsy Gleason score, and number of positive biopsies. All specimens were processed with the same method of pathologic evaluation. The results were compared using either the chi-square test or Student t test. RESULTS: The mean prostate weight and rate of positive lymph nodes were similar in both groups. No statistical difference was observed in the distribution of either the radical prostatectomy Gleason score or the pathologic stage between the laparoscopic and retropubic groups. In contrast, the decrease in the rate of positive surgical margins was statistically significant in the laparoscopic approach compared with the retropubic approach (P <0.02), particularly in localized cancers (pT2). No difference was observed in either the length or the distribution of the margin location. The rate of positive apical margins in organ-confined disease was significantly decreased in the laparoscopic group. CONCLUSIONS: These results suggest that laparoscopic prostatectomy performed by trained surgeons does not lead to an increased risk of positive margins compared with the retropubic approach.

Adenocarcinoma↗