Laparoscopic radical prostatectomy. preliminary pathologic evaluation.

Abstract

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.