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Transperitoneal and extraperitoneal approaches to three-dimensional laparoscopic radical prostatectomy have similar clinical outcomes, according to a recent retrospective study.

Radical prostatectomy is among the best treatments for localized prostate cancer. Three-dimensional laparoscopic radical prostatectomy (3D LRP) has two main surgical approaches, namely 3D extraperitoneal LRP (3D ELRP) and 3D transperitoneal LRP (3D TLRP). There is a lack of research concerning the comparison of these two surgical approaches. 

A retrospective study published in the American Journal of Clinical and Experimental Urology compared the clinical effectiveness and safety of 3D ELRP versus 3D TLRP for prostate cancer.

Study Population

The participants were categorized into the 3D TLRP (n = 39) and 3D ELRP (n = 43) groups. The mean age was 68 and 71 years in the 3D TLRP and 3D ELRP groups, respectively. There were no significant differences in the preoperative clinical data between the two groups.

3D Laparoscopic Prostatectomy Differs in Operative Time and Recovery Metrics

Comparison of the intraoperative and postoperative data between the 3D TLRP and 3D ELRP groups revealed that the differences between the groups regarding the intraoperative blood transfusion rate (12.82% vs. 2.33%), positive surgical margin rate (12.82% vs. 6.98%), positive lymph node rate (11.11% vs. 2.38%), pathological Gleason score, postoperative clinical stage, and perioperative complication rate (10.26% vs. 4.65%) were not statistically significant (all p>0.05). 

The 3D TLRP group, compared to the 3D ELRP group, demonstrated a longer operative time (approximately 232.36 vs. 212.07 minutes), more estimated blood loss (150 mL vs. 100 mL), longer gastrointestinal function recovery (approx. 2.72 vs. 2.26), longer drainage tube retention (approx. 5.69 vs. 4.28), and longer hospitalization (12.54 days vs. 10.88 days), with statistical significance (p<0.05).

Surgical Complications Similar in Both Groups

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The difference between the two groups regarding complications was not statistically significant. One case of urinary fistula, one case of lymphovascular fistula, one case of intestinal obstruction, and one case of infectious fever were documented in the 3D TLRP group, whereas one case of anastomotic fistula and one case of infectious fever were documented in the 3D ELRP group. All of these patients recovered with conservative treatment.

Follow-Up Revealed No Significant Differences in Surgical Outcomes Between Groups

Comparison at postoperative follow-up revealed no statistically significant differences between the 3D TLRP and 3D ELRP groups in terms of immediate urinary control rate (56.41% vs. 58.14%), 3-month postoperative urinary control rate (76.92% vs. 74.42%), 6-month postoperative urinary control rate (87.18% vs. 83.72%), 6-month postoperative sexual function recovery rate (2.56% vs. 2.33%), and 6-month postoperative biochemical recurrence rate (7.69% vs. 9.30%) (all p>0.05).

In conclusion, 3D TLRP and 3D ELRP have comparable oncologic and functional outcomes. The clinical decision regarding the preferred surgical approach to the two can be based on the patient’s specific situation and the surgeon’s experience.

Source:

Fu, J., Luo, W., Ding, Y., Liu, X., Fang, W., & Yang, X. (2023). Clinical study of 3D laparoscopic radical prostatectomy by transperitoneal and extraperitoneal approaches. American journal of clinical and experimental urology, 11(6), 549–558. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749385/