title: Long-term oncological outcomes after laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  To investigate long-term oncological outcomes after laparoscopic radical prostatectomy (LRP). To identify parameters influencing recurrence-free survival in a single-institution series.
  
  
  METHODS
  All patients underwent LRP using the transperitoneal retrograde Heilbronn technique. High-risk patients received adjuvant treatment according to an institutional algorithm based on prostate-specific antigen (PSA), Gleason score, tumour-node-metastasis stage, margin status and tumour volume. Data were collected prospectively on operative and postoperative parameters beginning in 1999. Complete follow-up data of 370 of the first 500 consecutive patients are available. Biochemical recurrence was defined as two consecutive PSA levels <0.2 ng/mL within the follow-up period. Kaplan-Meier estimates and Cox regression were applied to examine recurrence-free survival times.
  
  
  RESULTS
  The estimated biochemical recurrence-free survival (BCRFS) rates 10 years after LRP were 80.2% in patients staged pT2, 47.4% in those staged pT3a and 49.8% in those staged pT3b/4, confirming a better prognosis in patients with organ-confined disease (P < 0.001). In the multivariate Cox regression analysis, only Gleason score and pT stage significantly influenced BCRFS. The 10-year clinical progression-free survival rates were 97.2% (pT2), 84.4% (pT3a) and 78.1% (pT3b/4), and prostate cancer-specific survival estimates were 100% (pT2), 97.3% (pT3a) and 90.6% (pT3b/4).
  
  
  CONCLUSIONS
  The 10-year biochemical and clinical progression-free survival after LRP combined with a risk-adapted concept of adjuvant therapy is high, while prostate-cancer specific mortality is low. Our data shows no negative impact of laparoscopic techniques on oncologic outcomes compared to large series after retropubic radical prostatectomy. In a multivariate Cox regression, only Gleason score and pT stage had significant impact on BCRFS.
authors: Department of Urology, SLK-Kliniken, Heilbronn, Germany. marcel.hruza@gmail.com
authors: Marcel
authors: M
authors: Hruza
authors: Justo Lorenzo
authors: JL
authors: Bermejo
authors: Bettina
authors: B
authors: Flinspach
authors: Michael
authors: M
authors: Schulze
authors: Dogu
authors: D
authors: Teber
authors: Hans Joachim
authors: HJ
authors: Rumpelt
authors: Jens Jochen
authors: JJ
authors: Rassweiler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D004812:Epidemiologic Methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D061646:Operative Time; D011468:Prostatectomy / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000726:Androgen Antagonists