radical prostatectomy sept 2009 till aug 2010
DESCRIPTION
Radical Prostatectomy Sept 2009 till Aug 2010. South Mersey Cancer Network Manal Kumar Consultant Urologist. Radical Prostatectomy. 80 patients 17 open (1/16) 42 to 73 yrs (63 yrs) 63 laparoscopic 44 to 74 yrs (63 yrs) Two patients did not undergo lap prostatectomy Extensive adhesions - PowerPoint PPT PresentationTRANSCRIPT
Radical Prostatectomy Sept 2009 till Aug 2010
South Mersey Cancer Network
Manal KumarConsultant Urologist
Radical Prostatectomy
• 80 patients• 17 open (1/16)– 42 to 73 yrs (63 yrs)
• 63 laparoscopic– 44 to 74 yrs (63 yrs)– Two patients did not undergo
lap prostatectomy• Extensive adhesions• Incidental bladder tumour
Pre op PSA
• Open – 4.2 to 18.8ng/ml(9.5ng/ml)
• Lap RP– 0.8 to 29.7 ng/ml (8.5ng/ml)
Patient Selection
All risk categoriesPrevious operations
TURPs, inguinal and para-
umbilical hernia appendicectomy
BMI up to 38 Prostate volume
18 to 150 cc
Pre op Staging
Pre op Gleason Score
Risk Category
Lymphnode Dissection
Nerve Sparing Prostatectomy
OP Time
• Open RRP – 120 to 220 min (182 min)
• Lap RP – 150 to 270 min (201 min)
OP Time
Blood Loss
• Open RRP – 500 ml to 3000 ml (1400ml)– Data was not recorded for 10
patients– One patient had blood
transfusion
• Lap RP – 50 to 1000 ml (265 ml)–No blood transfusion
Laparoscopic Prostatectomy Complications
• One (1.6%) incisional hernia (Clavien 3b)• One (1.6%) lymphocele (Clavien 3a)• One (1.6%) peno- bulbar stricture (Clavien
3a)• One blocked catheter (Clavien 1)• One patient had mild haematuria (Clavien 1)• No transfusion, no ileus and no conversion to
open surgery• No anastamotic strictures
Length of Stay
• Open prostatectomy – 3 to 8 days (5.9 days)
• Lap prostates – 2-6 days (2.3 days)– All except two patients were
discharged within 3 days
Positive Surgical Margins
• Overall 26/71 (36%)• Open– 7/14 (50%) – 6 T3a
• Laparoscopic prostatectomy – 19/57 (33%)– 8 T3a– 3 T3b– Only one bladder neck positive
Post Operative PSA
PSA <0.1ng/ml94%Only 4 (6%) of LRP patients have
PSA above 0.1%Two of these patients had T3b
disease and three of the four have Gleason 4+4 disease
13/14 (92%) open prostatectomy patients had PSA <0.1 ng/ml
Continence
• 50 patients with > 3 mths follow up
• Four (8%) wearing more than one pad a day
• 2/12 open prostatectomy patients wearing more than one pad a day
Acknowledgement
Gill Riley