Document Detail

Does intrafascial dissection during nerve-sparing laparoscopic radical prostatectomy compromise cancer control?
MedLine Citation:
PMID:  20063449     Owner:  NLM     Status:  MEDLINE    
To assess whether oncological outcomes are compromised by adopting the curtain dissection (CD) technique (high incision of the peri-prostatic fascia) during nerve-preserving radical prostatectomy (RP). PATIENTS AND METHODS: In all, 973 laparoscopic RPs (LRPs) were performed or supervised by one surgeon between March 2000 and October 2007 for cT1-3 N0M0 prostate cancer, of which 510 included bilateral neurovascular bundle preservation. A CD technique was used in 240 men and a standard dissection (StD) technique was used in 270, considered the control group. The technique was extraperitoneal, used five ports and included preservation of the seminal vesicle tips. Thermal energy was not used posterior or lateral to the prostate in either group. Patient, operative and oncological outcome variables were compared using an independent-sample t-test if continuous or with Fisher's exact test for rates. RESULTS: Patient and cancer characteristics before LRP were similar for the CD and StD groups, and there were no significant perioperative differences either. Positive margins occurred in 11.7% of the CD group and 11.1% of the StD group (P = 0.95). At a mean (range) follow-up of 11.7 (3-24) months for the CD group and 13.1 (3-24) months for the StD group, biochemical recurrence rates were 0% and 1.1%, respectively (P = 0.30). Potency (CD, 62%; StD, 61%; P = 0.89) and continence rates (StD, 97%; CD, 98%; P = 0.83) were comparable between the groups, but there was a statistically significant earlier return to continence in the CD group (P < 0.001 at 3 months). CONCLUSIONS: For carefully selected men there appears to be no compromise in cancer control with intrafascial dissection in the short term. However, equally there appears to be no significant improvement in potency after LRP. The earlier return to continence after intrafascial nerve-sparing suggests reduced dissection of periurethral supports rather than preservation of additional autonomic nerve fibres.
Mischel G Neill; Mark Louie-Johnsun; Charles Chabert; Christopher Eden
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  BJU international     Volume:  104     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2010-01-08     Completed Date:  2010-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  1730-3     Citation Subset:  IM    
Royal Surrey County Hospital, Guildford, Surrey, UK.
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MeSH Terms
Case-Control Studies
Dissection / methods
Intraoperative Complications / prevention & control*
Middle Aged
Prostate / innervation*,  surgery
Prostatectomy / adverse effects,  methods*
Prostatic Neoplasms / pathology,  surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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