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1635 IMPLICATIONS OF LAPAROSCOPIC INGUINAL HERNIA REPAIR ON OPEN, LAPAROSCOPIC AND ROBOTIC RADICAL PROSTATECTOMY
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THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
1636 DOES LYMPH NODE INVASION IMPACT BIOCHEMICAL RECURRENCE FREE SURVIVAL (BCRFS) FOLLOWING RADICAL PROSTATECTOMY IN MEN WITH SEMINAL VESICLE INVASION? Chris Wambi*, John Ceccio, Gregory Hruby, Mitchell C. Benson, James M. McKiernan, New York, NY
Source of Funding: None
1635 IMPLICATIONS OF LAPAROSCOPIC INGUINAL HERNIA REPAIR ON OPEN, LAPAROSCOPIC AND ROBOTIC RADICAL PROSTATECTOMY Daniel Spernat*, Henry Woo, Sydney, Australia; David Sofield, Perth, Australia; Daniel Moon, Melbourne, Australia; Mark Louie-Johnsun, Gosford, Australia INTRODUCTION AND OBJECTIVES: Radical Prostatectomy (RP) can be a challenging operation. Further, tissue planes may be compromised by previous Laparoscopic Inguinal Hernia Repair (LIHR). Surgeons have anecdotally reported that RP has had to be abandoned after LIHR. We prospectively collected data from four experienced prostate surgeons from separate institutions. We report on our experience with open RP (ORP), laparoscopic RP (LRP) and robotic assisted RP (RARP). Our objective was to evaluate the success rate of performing RP with the three most common operative techniques, Lymph Node Dissection (LND), and the frequency of complications after LIHR. METHODS: A prospective database recorded clinical and pathological T stage, PSA, Gleason grade, success or failure to perform RP, success or failure to perform LND, unilateral or bilateral mesh, type of RP and complications. RESULTS: A total of 57 men underwent RP after LIHR. 28 had a previous bilateral LIHR, and 29 unilateral. An ORP was attempted in 19 patients, LRP in 33, and RARP in 5. All 57 cases were able to be successfully completed. LND was based on individual surgeon preference. Of the 19 ORP a LND was attempted in 18 cases. Only 10 of the 18 open LND were able to be completed (55.6%). Of the 33 laparoscopic cases, LND was attempted in 22. Only 4 (18.2%) of these cases were able to have a bilateral LND and a further 9 (40.9%) had a unilateral dissection. Robotic LND was possible in 5 of 5 cases (100%). Combining data from all methods of RP, a LND was attempted in 44 of the 57 patients (77.2%). The LND had to be abandoned in 16 (36.4%) of the patients. Additionally in 9 (20.5%) patients only a unilateral LND was possible due to mesh covering the nodes and external iliac vessels. Thus it was not possible to complete a LND in 25 of the 44 patients (56.8%). Complications were limited to ten patients. These complications included one LRP converted to ORP due to failure to progress, one rectourethral fistula in a salvage procedure post failed HIFU, one bladder tear, two blood transfusions, one prolonged lymph leak (5 days), one urinoma, one episode of acute urinary retention, one wound infection, and one bladder neck contracture. CONCLUSIONS: LIHR is not a contra-indication to RP. ORP, LRP, and RARP after LIHR is a safe and reasonable treatment option for patients with prostate cancer. However, it may not be possible to perform a LND in up to 56.8% of patients. Thus prior to undertaking LIHR, a PSA and DRE should be performed in age appropriate men. Further, minimally invasive approaches may offer higher success rates with LND compared to open surgery following LIHR. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Men with lymph node invasion (LNI) or seminal vesicle invasion (SVI) are at high risk of treatment failure and disease progression. Several studies in men with SVI excluded patients with concomitant LNI. The aim of this study was to compare clinical features between men with pT3bN0 and pT3bN1 tumors and to determine whether LNI affects BCRFS in men with SVI. METHODS: A retrospective analysis of the IRB-approved urologic oncology database of patients who underwent radical prostatectomy from 1990 –2010 at our institution was conducted. We identified 176 patients with SVI, pT3bN0 (n⫽158) and pT3bN1 (n⫽18), who were treated with surgery alone. Biochemical recurrence was defined as PSA ⬎ 0.2 ng/mL or implentation of additional treatments. KaplanMeier analysis was used to compare BCRFS and Cox proportional hazards models were used to assess determinants of BCRFS. RESULTS: Median follow up and age were 58 months and 62 years old for both groups while median PSA was 14.2 and 22.4 ng/mL (p⫽0.1), for men with pT3bN0 and pT3bN1 tumors respectively. Lymph node invasion was associated with higher biopsy (p⬍0.001) and pathologic Gleason scores (p⫽0.01) as well as lymph node yield (p⬍0.001). There were no differences in clinical stage, ethnicity or surgical margin status between both groups. Lymph node invasion was not a determinant of BCRFS on univariate or multivariate analysis, HR 1.21 (95%CI, 0.61–2.39, p⫽0.59) and 1.68 (95%CI, 0.76 –3.71, p⫽0.20) respectively. Median BCRFS was 51 and 4 months for pT3bN0 and pT3bN1 patients. On multivariable analysis PSA and pathologic Gleason score were the only determinants of BCRFS. CONCLUSIONS: The majority of patients with SVI experience biochemical recurrence with long-term follow-up although men with pT3bN0 tumors have longer BCRFS. Pre-operative PSA and pathologic Gleason score should be considered when recommending adjuvant treatments in men with SVI.
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
1636 DOES LYMPH NODE INVASION IMPACT BIOCHEMICAL RECURRENCE FREE SURVIVAL (BCRFS) FOLLOWING RADICAL PROSTATECTOMY IN MEN WITH SEMINAL VESICLE INVASION? Chris Wambi*, John Ceccio, Gregory Hruby, Mitchell C. Benson, James M. McKiernan, New York, NY
Source of Funding: None
1635 IMPLICATIONS OF LAPAROSCOPIC INGUINAL HERNIA REPAIR ON OPEN, LAPAROSCOPIC AND ROBOTIC RADICAL PROSTATECTOMY Daniel Spernat*, Henry Woo, Sydney, Australia; David Sofield, Perth, Australia; Daniel Moon, Melbourne, Australia; Mark Louie-Johnsun, Gosford, Australia INTRODUCTION AND OBJECTIVES: Radical Prostatectomy (RP) can be a challenging operation. Further, tissue planes may be compromised by previous Laparoscopic Inguinal Hernia Repair (LIHR). Surgeons have anecdotally reported that RP has had to be abandoned after LIHR. We prospectively collected data from four experienced prostate surgeons from separate institutions. We report on our experience with open RP (ORP), laparoscopic RP (LRP) and robotic assisted RP (RARP). Our objective was to evaluate the success rate of performing RP with the three most common operative techniques, Lymph Node Dissection (LND), and the frequency of complications after LIHR. METHODS: A prospective database recorded clinical and pathological T stage, PSA, Gleason grade, success or failure to perform RP, success or failure to perform LND, unilateral or bilateral mesh, type of RP and complications. RESULTS: A total of 57 men underwent RP after LIHR. 28 had a previous bilateral LIHR, and 29 unilateral. An ORP was attempted in 19 patients, LRP in 33, and RARP in 5. All 57 cases were able to be successfully completed. LND was based on individual surgeon preference. Of the 19 ORP a LND was attempted in 18 cases. Only 10 of the 18 open LND were able to be completed (55.6%). Of the 33 laparoscopic cases, LND was attempted in 22. Only 4 (18.2%) of these cases were able to have a bilateral LND and a further 9 (40.9%) had a unilateral dissection. Robotic LND was possible in 5 of 5 cases (100%). Combining data from all methods of RP, a LND was attempted in 44 of the 57 patients (77.2%). The LND had to be abandoned in 16 (36.4%) of the patients. Additionally in 9 (20.5%) patients only a unilateral LND was possible due to mesh covering the nodes and external iliac vessels. Thus it was not possible to complete a LND in 25 of the 44 patients (56.8%). Complications were limited to ten patients. These complications included one LRP converted to ORP due to failure to progress, one rectourethral fistula in a salvage procedure post failed HIFU, one bladder tear, two blood transfusions, one prolonged lymph leak (5 days), one urinoma, one episode of acute urinary retention, one wound infection, and one bladder neck contracture. CONCLUSIONS: LIHR is not a contra-indication to RP. ORP, LRP, and RARP after LIHR is a safe and reasonable treatment option for patients with prostate cancer. However, it may not be possible to perform a LND in up to 56.8% of patients. Thus prior to undertaking LIHR, a PSA and DRE should be performed in age appropriate men. Further, minimally invasive approaches may offer higher success rates with LND compared to open surgery following LIHR. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Men with lymph node invasion (LNI) or seminal vesicle invasion (SVI) are at high risk of treatment failure and disease progression. Several studies in men with SVI excluded patients with concomitant LNI. The aim of this study was to compare clinical features between men with pT3bN0 and pT3bN1 tumors and to determine whether LNI affects BCRFS in men with SVI. METHODS: A retrospective analysis of the IRB-approved urologic oncology database of patients who underwent radical prostatectomy from 1990 –2010 at our institution was conducted. We identified 176 patients with SVI, pT3bN0 (n⫽158) and pT3bN1 (n⫽18), who were treated with surgery alone. Biochemical recurrence was defined as PSA ⬎ 0.2 ng/mL or implentation of additional treatments. KaplanMeier analysis was used to compare BCRFS and Cox proportional hazards models were used to assess determinants of BCRFS. RESULTS: Median follow up and age were 58 months and 62 years old for both groups while median PSA was 14.2 and 22.4 ng/mL (p⫽0.1), for men with pT3bN0 and pT3bN1 tumors respectively. Lymph node invasion was associated with higher biopsy (p⬍0.001) and pathologic Gleason scores (p⫽0.01) as well as lymph node yield (p⬍0.001). There were no differences in clinical stage, ethnicity or surgical margin status between both groups. Lymph node invasion was not a determinant of BCRFS on univariate or multivariate analysis, HR 1.21 (95%CI, 0.61–2.39, p⫽0.59) and 1.68 (95%CI, 0.76 –3.71, p⫽0.20) respectively. Median BCRFS was 51 and 4 months for pT3bN0 and pT3bN1 patients. On multivariable analysis PSA and pathologic Gleason score were the only determinants of BCRFS. CONCLUSIONS: The majority of patients with SVI experience biochemical recurrence with long-term follow-up although men with pT3bN0 tumors have longer BCRFS. Pre-operative PSA and pathologic Gleason score should be considered when recommending adjuvant treatments in men with SVI.