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Radical Prostatectomy Sept 2009 till Aug 2010

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

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Radical Prostatectomy Sept 2009 till Aug 2010

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  1. Radical Prostatectomy Sept 2009 till Aug 2010 South Mersey Cancer Network Manal Kumar Consultant Urologist

  2. 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

  3. 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)

  4. Patient Selection • All risk categories • Previous operations • TURPs, • inguinal and para-umbilical hernia • appendicectomy • BMI up to 38 • Prostate volume • 18 to 150 cc

  5. Pre op Staging

  6. Pre op Gleason Score

  7. Risk Category

  8. Lymphnode Dissection

  9. Nerve Sparing Prostatectomy

  10. OP Time • Open RRP • 120 to 220 min (182 min) • Lap RP • 150 to 270 min (201 min)

  11. OP Time

  12. 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

  13. 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

  14. 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

  15. 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

  16. Post Operative PSA • PSA <0.1ng/ml 94% • 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

  17. 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

  18. Acknowledgement Gill Riley

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