NEW YORK--Initial enthusiasm accompanying the introduction of
laparoscopy in the diagnosis and treatment of prostate cancer
has given way to a more realistic assessment of its value, R.
Ernest Sosa, MD, said at a conference on prostate cancer at Lenox
Hill Hospital. It continues to have value, but its role is limited
and is unlikely to broaden.
Dr. Sosa, associate professor of urology at Cornell University
Medical College, praised laparoscopy as a tool in staging as well
as dissection when lymph node metastases have been identified.
He cautioned, however, that laparoscopy should be done only when
there is a high likelihood of node involvement.
In selected patients, laparoscopy offers as advantages shorter
hospital stay, lower costs (because of shorter stay), rapid convalescence,
and reduced morbidity, compared with conventional surgery. On
the down side, however, the procedure adds about 2 hours to surgical
time and requires special expertise, making it a more expensive
operation to perform.
The key to using laparoscopy effectively, Dr. Sosa said, lies
in patient selection. Patients with T1a and T1b disease are not
good candidates because of the lower likelihood of positive nodes.
In patients with later stage disease and high Gleason scales,
the value of laparoscopy increases.
The complication rate has improved from 15% in 1991 to 6% today,
and the time required to perform the procedure has been reduced,