Long-term oncological outcomes after laparoscopic radical prostatectomy
A partir de données administratives portant sur 370 patients atteints d'un cancer de la prostate à risque élevé de récidive, cette étude prospective évalue, du point de vue de la survie sans récivive biochimique, de la survie sans progression et de la mortalité spécifique, les résultats à 10 ans d'une prostatectomie radicale par laparoscopie en fonction du stade de la maladie au diagnostic
Study Type – Therapy (outcomes)Level of Evidence 2b“What's known on the subject?” and “What does the study add?”Laparoscopic radical prostatectomy (LRP) has shown good oncological short-term and mid-term outcomes, but long-term outcomes are still lacking.We present long-term oncological outcomes of LRP in a large cohort of patients operated on in one of the pioneering European centres. The data from the present study show high rates of biochemical and clinical recurrence-free survival and low cancer-specific mortality compared with open series. OBJECTIVES * •To investigate long-term oncological outcomes after laparoscopic radical prostatectomy (LRP). * •To identify parameters influencing recurrence-free survival in a single-institution series. PATIENTS AND METHODS * •All patients underwent LRP using the transperitoneal retrograde Heilbronn technique. High-risk patients received adjuvant treatment according to an institutional algorithm based on prostate-specific antigen (PSA), Gleason score, tumour-node-metastasis stage, margin status and tumour volume. * •Data were collected prospectively on operative and postoperative parameters beginning in 1999. Complete follow-up data of 370 of the first 500 consecutive patients are available. * •Biochemical recurrence was defined as two consecutive PSA levels >0.2 ng/mL within the follow-up period. * •Kaplan–Meier estimates and Cox regression were applied to examine recurrence-free survival times. RESULTS * •The estimated biochemical recurrence-free survival (BCRFS) rates 10 years after LRP were 80.2% in patients staged pT2, 47.4% in those staged pT3a and 49.8% in those staged pT3b/4, confirming a better prognosis in patients with organ-confined disease (P < 0.001). * •In the multivariate Cox regression analysis, only Gleason score and pT stage significantly influenced BCRFS. * •The 10-year clinical progression-free survival rates were 97.2% (pT2), 84.4% (pT3a) and 78.1% (pT3b/4), and prostate cancer-specific survival estimates were 100% (pT2), 97.3% (pT3a) and 90.6% (pT3b/4). CONCLUSIONS * •The 10-year biochemical and clinical progression-free survival after LRP combined with a risk-adapted concept of adjuvant therapy is high, while prostate-cancer specific mortality is low. Our data shows no negative impact of laparoscopic techniques on oncologic outcomes compared to large series after retropubic radical prostatectomy. * •In a multivariate Cox regression, only Gleason score and pT stage had significant impact on BCRFS.