Figure 3 Correlation between blood loss and the number of case
Discussion
Cancer of the prostate is important in male in Thailand. Radical prostatectomy is one of the curative treatments for localized prostate cancer. The 10-year specific survival rate after this operation is greater than 85% 3,4. However, because of potential perioperative morbidity of open surgery, minimally invasive surgery by laparoscopy is an original approach designed to achieve the same oncological results as conventional radical prostatectomy while decreasing the morbidity of this operation 5.
The present study reported data on perioperative parameters and morbidities. The overall results were comparable to other reported studies both in Thailand and other countries as shown in Table 2.
The median operative time in this series was 180 min which was shorter than other reported series (208-350 min) 6-11. The operative time was more than 250 minutes in the first five patients, but as the surgeon gained more experience, it became shorter. The rate of conversion to open surgery was less than two times compared to the report by Chaiyong et al 10. The transfusion rate of 10% in our series was comparable to the rate reported by Bollens et al. 9 and it was less than other reported series from Thailand (16.7-27.6%) 10,11. The better outcome in this cohort was partly due to the major advancement in laparoscopic technology; visual guidance and surgical technique over the last decade and the better postoperative care improvement.
Table 2 Comparison of operative outcomes and complications of this series with that previously reported.
Study |
n |
Mean/
median operative time (min) |
Mean
/median blood loss (mL) |
Conver-sion rate (%) |
LOH (days) |
Transfu-sion rate (%) |
Positive margin (%) |
C/P |
Guillonneau et al 6
(1999) |
59 |
265 |
400 |
9.2 |
4.5 |
15.4 |
12.3 |
1 Rectal injury
1 Bleeding |
Abbou et al 7
(2000) |
10 |
258 |
NA |
0 |
9 |
4.7 |
27.9 |
1 Rectal injury
4 Urine leakage |
Turk et al 8
(2001) |
125 |
255 |
185 |
0 |
8 |
2 |
26.4 |
3 Rectal injury |
Bollens et al 9
(2001) |
50 |
317 |
680 |
2 |
NA |
13 |
22 |
NA |
Chaiyong et al 10
(2006) |
56 |
350 |
883 |
16 |
NA |
27.6 |
29.8 |
1 Rectal injury
5 Urine leakage |
Patkawat et al 11
(2011) |
24 |
208 |
295 |
NA |
6.1 |
16.7 |
20 |
NA |
Present series
(2019) |
20 |
180 |
400 |
5 |
5 |
10 |
30 |
1 Delayed bleeding
1 Urine leakage |
Early experience of LRP resulted in 9.6-36% of complications 9, 12. In this series, the complication rate was 15% which was acceptable, and there was no post-operative mortality.
From the oncological point of view, it is still too early to evaluate the long-term results from the present series. The overall positive surgical margin rate was 30% which was slightly higher compared to many series with the positive margin of 12.3%- 29.8% 6-11. The patients' high T stage of pT3b in 30% of patients could have contributed to this higher rate of positive margin.
This study reported the outcomes and morbidity of LRP from the first case series. The present series included the initial experience period that is needed to contribute the skills required for success. However, the complication rates were minor complications and no mortality in the present series. This indicated that the author technique and experience for LRP can be a standard method for prostate cancer surgery in Srinagarind hospital.
Conclusion
Perioperative outcomes of LRP in the first 20 cases were satisfactory, based on the experience of the surgeon. The morbidity was acceptable. This operation was safe and feasible in Srinagarind hospital.
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