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 Incidental bladder tumour

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)

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

Pre op Staging

Pre op Gleason Score

Risk Category

Lymphnode Dissection

Nerve Sparing Prostatectomy

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

OP Time

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

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

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

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

Post Operative PSA PSA <0.1ng/ml94% 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

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

Acknowledgement Gill Riley