Interfascial laparoscopic radical prostatectomy for high-risk prostate cancer: improved functional results, inferior oncologic outcome

==inizio abstract==


This study compares the outcomes of interfascial versus extrafascial techniques of LRP for HRPCa at a single institution.

Material and Methods:
Between October 2007-January 2013 119 patients affected by HRPCa underwent LRP; 78 patients underwent ILRP (group A) and 41 preceding patients who underwent extrafascial LRP (eLRP) were identified as controls (group B). Preoperative potency, tumor stages ≥T2c, prostate -specific
antigen level ≥10 ng/mL, and maximal Gleason score 3+4 (not 4+3) were considered as candidates for ILRP. Perioperative data, functional and oncologic outcomes were reviewed. Continence rates, QoL and potency rates were assessed by self- administered validated questionnaires
(ICIQ-SF; SF-36; IIEF-5).

Perioperative characteristics and complication rates were similar between the two groups. Continence rates at 1, 3, and 6 months increased from 36%, 46%, and 71%, respectively, after eLRP to 66%, 70%, and 72% after ILRP. Potency rates at 3, 6, and 9 months in the B were 6.5%, 13.4%, and 26.6%, respectively, whereas in the A group they improved to 14.2%, 27.6%, and 38.8%. The rates of PSMs in pT2 disease were 24.5% in the B group and 29.2% in the A group (p=0,21), whereas in pT3, PSMs were 31.2% in the extrafascial group and 43,4% in the interfascial group (p < 0.004). In the A group patients with PSMs had significant smaller prostates (P = .00016) and higher pathologic stages (P < .00055) Discussion: ILRP slightly improves potency rate and shortened the time to return of continence. This improved outcome, though, was achieved at the price of higher PSM rates in patients with pT3 disease. A lower prostate weight is associated with higher probability of PSM in high-risk patients undergoing ILRP. Conclusion: Interfascial dissection compared to the eLRP allows a partial nerve-sparing surgery but this approach has a limited indication in the treatment of HRPCa. ==fine abstract==