NEW ORLEANSTransperitoneal laparoscopic radical prostatectomy
achieves negative surgical margins comparable to those achieved with the open
retropubic approach, according to a study from University of Massachusetts
Medical School investigators. They reported their results at the American
College of Surgeons 87th Clinical Congress.
The reproducibility of laparoscopic prostatectomy has already been
demonstrated in several large series, and a number of theoretical advantages
have been suggested: improved surgical visualization, decreased operative
morbidity, and increased cosmesis.
However, to justify the adoption of this new technique as a cancer
operation, it is important to show that adequate surgical margins can be
achieved in a reproducible manner, said Vernon Pais, Jr., MD, of the Division
of Urology, Department of Surgery.
"There have been several major obstacles to more widespread
acceptance," he said. "One is the so-called steep learning curve.
Many have questioned the utility of developing a technically challenging
alternative to what is a well-tested, established, and reproducible procedure
at which most urologic surgeons are quite well trained." Another issue is
that the procedure remains unproven. "There is very limited experience and
no long-term follow-up," he said.
Dr. Pais shared the experience at his institution, where about 70
laparoscopic prostatectomies have been performed to date. The research team
compared the surgical margins of 37 consecutive patients undergoing laparoscopy
with those of the most recent 37 patients undergoing open procedures. The same
surgeons performed all the procedures.
Any specimen in which tumor extended to the margin was considered to
represent a positive surgical margin.
Dr. Pais reported there was no evidence of cancer at the surgical margins in
33 of the 37 laparoscopic patients (89%), and in 29 of the 37 patients
undergoing the open approach (78%). Overall, the positive surgical margin rate,
therefore, was 11% in the laparoscopic group and 22% in the open prostatectomy
group.