Does posterior reconstruction significantly affect the outcomes of laparoscopic radical prostatectomy in the high-risk setting? Results from a prospective non-randomized series with a personal modified Rocco’s technique

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Background and Objectives
To detail the technique and to evaluate the impact of a personal modified posterior reconstruction technique (PDR) on the outcomes of extrafascial laparoscopic radical prostatectomy (eLRP) in a consecutive series of 52 patients affected by high-risk prostate cancer (HRPCa).

From October 2007 to March 2012 52 patients underwent PDR during eLRP for HRPCa. 54 patients who underwent eLRP for HRPCa with no PDR were considered as historical controls. Mean operative time (MOT); mean catheterization time (MCT); % continence and quality of life (QoL) at a scheduled follow- up; % anastomotic leakage; % adjuvant therapy were compared between the groups. % Continence and QoL were prospectively assessed by self-administered validated questionnaires (ICI-Q-SF; SF-36) at 1,3,6,12 months.

PDR was associated to higher continence rates at 1,3 months, (p = 0.028; 0.006) a lower incidence of cystographic leakage (p=0.002) and an increased adjuvant radiotherapy rate (p=0.008). At 1- and 3-months interval, in the PDR group, we found an higher number of patients reporting better general health perception, (p=0.01; p=0.03) reduced role limitations due to physical health, (p=0.02; p=0.001) and emotional problems (p=0.001; p=0.02).


PDR is associated to a lower anastomotic leakage and it significantly enhances urinary continence at 1,3 months. The increased adjuvant radiotherapy rate and quality of life after surgery observed with our technique suggest that in the high-risk setting an early functional recovery may substantially influence the oncologic outcome of eLRP.

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