Initial results of salvage laparoscopic radical prostatectomy after radiation failure.
OBJECTIVE
We evaluated the feasibility of laparoscopic radical prostatectomy for recurrence after irradiation.


METHODS
Since 2000, 7 patients with biological failure after irradiation (5 external beam radiation and 2 brachytherapy), and no metastasis on computerized tomography and bone scan underwent a transperitoneal laparoscopic radical prostatectomy according to the Montsouris technique. The left index finger was placed in the rectum to control the prostatorectal dissection. We call this procedure "finger assisted laparoscopy."


RESULTS
Average operating time was 190 minutes (range 170 to 210), average blood loss was 387 cc (range 50 to 1,100) and no patient was transfused. Bladder catheter was removed after an average of 13 days because of the slower tissue healing after irradiation. No death or intraoperative complication occurred. There was no conversion to open surgery. Average postoperative stay was 6.4 days. Average followup was 11.2 months. Of the 7 patients 5 are continent (no pad day or night) and 2 have stress incontinence. All patients are impotent. No patient had urethral stenosis or lymphocele. Prostate specific antigen is lower than 0.1 ng/ml in 5 patients and higher in 2.


CONCLUSIONS
Laparoscopic salvage radical prostatectomy after irradiation is feasible with no more morbidity than an open procedure. A longer followup is mandatory to evaluate its usefulness.
Vallancien
Guy
G
Department of Urology, Institut Montsouris, Université Pierre et Marie Curie, Paris 75014, France. guy.vallancien@imm.fr
Gupta
Roby
R
Cathelineau
Xavier
X
Baumert
Hervé
H
Rozet
François
F
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy / Q000601:surgery*; D016879:Salvage Therapy
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen