Intrafascial Radical Prostatectomy Research Articles

Effect of modified extraperitoneal laparoscopic total intrafascial radical prostatectomy on clinical efficacy for prostate cancer patients

The effective surgical treatments of localized prostate cancer patients were explored. 90 prostate cancer patients admitted to our hospital were selected as study subjects. They were divided into research (treated by modified extraperitoneal total intrafascial laparoscopic radical prostatectomy) and control (treated by extraperitoneal laparoscopic radical prostatectomy) groups by random number table method, having 45 cases each. The operation time, bleeding volume, drainage time, hospitalization time, vascular endothelial stimulation index, urinary control function, erectile function, complications, and recurrence were monitored and compared. No significant difference was found between the two groups in clinical operation related indexes. On 3rd and 7th days after operation, VEGF (Vascular Endothelial Growth Factor) and IGF-I (Insulin-like Growth Factor 1) in research group were lower than those in control (p < 0.005). The urine control rate and erectile function normal rate in research group were higher than those in control (p < 0.005). Modified extraperitoneal laparoscopic total intrafascial radical prostatectomy reduced the degrees of trauma and irritation in the operation of prostate cancer patients. Moreover, during the observation period, it improved the postoperative urinary control and erectile function of patients and reduced the complications. Thus, this method has the worth of clinical promotion and application.

Oncological safety of intrafascial nerve-sparing radical prostatectomy compared with conventional process: a pooled review and meta-regression analysis based on available studies

BackgroundIntrafascial prostatectomy was a modified technique from the conventional nerve-sparing surgery in order to improve patients’ post-surgical continence and erectile function; however, ongoing controversy exists regarding the oncological safety of this technique. In this study we aimed to provide a critical and pooled analysis based on published literatures regarding the oncological outcomes after intrafascial nerve-sparing prostatectomy.MethodsDatabase searches were performed for published articles till June 2018 on PubMed. Three reviewers screened fulfilled papers and extracted data independently. Main outcome was the positive surgical margins (PSMs) rates stratified by pathological stages. We performed both one-arm and comparative meta-analysis to evaluate the oncological safety of intrafascial technique. Moreover, we built meta-regression models to assess the confounding factors.ResultsWe retrieved a total of 117 records after electronic search, of which 21 studies were finally included in this review. There were 15 controlled studies and 6 surgical series. Our one-arm meta-analysis demonstrated that the total PSM rates after intrafascial techniques ranging from 2.2 to 35%, with a pooled rate of 14.5% on average (480 of 3151 patients, 95% confidence interval[CI]: 11.2–17.5%). Meta-regression model showed that patients’ age, pT2 cancer percentage and Selection Score of Oncological Safety (SSOS) were significantly associated with total PSM rate; moreover, each 1 point of SSOS could decrease the total PSM rate by 1.3% on average. Comparative meta-analysis demonstrated that there was no significant difference between intra- and inter-fascial group regarding PSM rates.ConclusionsWith stringent case selection and when performed by experienced surgeons, intrafascial prostatectomy could offer an acceptable or, at least, equivalent PSM rate compared with the conventional interfascial approach. Preoperative SSOS more than 7 points could be considered as an indication of intrafascial radical prostatectomy.

Comparison of intrafascial and non-intrafascial radical prostatectomy for low risk localized prostate cancer

In this meta-analysis study, we compared the oncological and functional outcomes of intrafascial radical prostatectomy (IFRP) with non-intrafascial radical prostatectomy (NIFRP) in the treatment of patients with low risk localized prostate cancer (PCa). Relevant articles were identified by searching PubMed, EMBASE, Cochrane Library, Ovid, and the ISI Web of Knowledge databases. A total of 2096 patients were included from 7 eligible studies. Results of the pooled data showed that the oncological outcomes including gleason score, positive surgical margin and biochemical free survival rates were similar between the two groups. IFRP was superior to NIFRP with lower postoperative complication rates (RR 0.57, 95% CI 0.38, 0.85, p = 0.006), higher continence rates at 3 months post-operation (RR: 1.14; 95% CI, 1.04, 1.26; p = 0.006), and higher potency rates at 6 months (RR: 1.53; 95% CI, 1.07, 2.18; p = 0.02) and 12 months post-operation (RR: 1.38; 95% CI, 1.11, 1.73; p = 0.005). Additionally, there was a tendency towards higher potency rate in patients ≤65 years old compared with patients >65 years old after IFRP. Overall, these findings suggest that IFRP in young patients with low risk localized PCa had less postoperative complications, shortened time to return to continence and improved potency rate without compromising complete tumor control.

PYJ04: Preliminary learning curve of robot-assisted laparoscopic intrafascial radical prostatectomy of a single surgeon with experience in more than 1,000 laparoscopic urologic surgeries: A comparative analysis with recently performed 100 laparoscopic radical prostatectomies

PYJ04: Preliminary learning curve of robot-assisted laparoscopic intrafascial radical prostatectomy of a single surgeon with experience in more than 1,000 laparoscopic urologic surgeries: A comparative analysis with recently performed 100 laparoscopic radical prostatectomies

Onkologische und funktionelle Ergebnisse der offenen intrafaszialen radikalen Prostatektomie

According to the recently published German-language S3 guidelines, various treatment options such as surgical management or radiation therapy are available to patients with locally advanced prostate cancer. Particularly the establishment of minimally invasive endoscopic surgical techniques, which provide better optical images, has made it possible to visualize tissue layers that are usually difficult to identify with the open surgical technique. This contribution describes a pilot study on the establishment of open intrafascial radical prostatectomy. The goal of the study is to critically analyze both the functional and especially the oncological results, which should not be compromised by the nerve-sparing approach.