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
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Radical Prostatectomy Sept 2009 till Aug 2010
South Mersey Cancer Network
Manal KumarConsultant Urologist
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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
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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)
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Patient Selection
All risk categoriesPrevious operations
TURPs, inguinal and para-
umbilical hernia appendicectomy
BMI up to 38 Prostate volume
18 to 150 cc
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Pre op Staging
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Pre op Gleason Score
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Risk Category
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Lymphnode Dissection
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Nerve Sparing Prostatectomy
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OP Time
• Open RRP – 120 to 220 min (182 min)
• Lap RP – 150 to 270 min (201 min)
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OP Time
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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
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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
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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
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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
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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
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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
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Acknowledgement
Gill Riley