title: Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results.
abstract: OBJECTIVE
  To prospectively compare the laparoscopic versus open approach to RP in cases with high prostate volume and to evaluate a possible diferente impact of prostate volume.
  
  
  METHODS
  From March 2007 to March 2013 a total of 120 cases with clinically localized prostate cancer (PC) and a prostate volume>70cc identified for radical prostatectomy (RP), were prospectively analyzed in our institute. Patients were offered as surgical technique either an open retropubic or an intraperitoneal laparoscopic (LP) approach. In our population, 54 cases were submitted to LP and 66 to open RP. We analyzed the association of the surgical technique with perioperative, oncological and postoperative functional parameters.
  
  
  RESULTS
  In those high prostate volume cases, the surgical technique (laparoscopic versus open) does not represent a significant independent factor able to influence positive surgical margins rates and characteristics (p=0.4974). No significant differences (p>0.05) in the overall rates of positive margins was found, and also no differences following stratification according to the pathological stage and nerve sparing (NS) procedure. The surgical technique was able to significantly and independently influence the hospital stay, time of operation and blood loss (p<0.001). On the contrary, in our population, the surgical technique was not a significant factor influencing all pathological and 1-year oncological or functional outcomes (p>0.05).
  
  
  CONCLUSIONS
  In our prospective non randomized analysis on high prostate volumes, the laparoscopic approach to RP is able to guarantee the same oncological and functional results of an open approach, maintaining the advantages in terms of perioperative outcomes.
authors.affiliation: Dipartimento di Urologia - Unità della prostata, Università La Sapienza, Roma, Italia.
authors.forename: Sciarra
authors.initials: S
authors.lastname: Alessandro
authors.affiliation: Dipartimento di Urologia - Unità della prostata, Università La Sapienza, Roma, Italia.
authors.forename: Gentilucci
authors.initials: G
authors.lastname: Alessandro
authors.affiliation: Dipartimento di Urologia - Unità della prostata, Università La Sapienza, Roma, Italia.
authors.forename: Cattarino
authors.initials: C
authors.lastname: Susanna
authors.affiliation: Dipartimento di Urologia - Unità della prostata, Università La Sapienza, Roma, Italia.
authors.forename: Innocenzi
authors.initials: I
authors.lastname: Michele
authors.affiliation: Dipartimento di Urologia - Unità della prostata, Università La Sapienza, Roma, Italia.
authors.forename: Di Quilio
authors.initials: DQ
authors.lastname: Francesca
authors.affiliation: Istituto Nazionale Italiano di Statistica - Ricercatore di Statistica, Roma, Italia.
authors.forename: Fasulo
authors.initials: F
authors.lastname: Andrea
authors.affiliation: Dipartimento di Urologia - Unità della prostata, Università La Sapienza, Roma, Italia.
authors.forename: Magnus
authors.initials: M
authors.lastname: Von Heland
authors.affiliation: Dipartimento di Urologia - Unità della prostata, Università La Sapienza, Roma, Italia.
authors.forename: Gentile
authors.initials: G
authors.lastname: Vincenzo
authors.affiliation: Dipartimento di Urologia - Unità della prostata, Università La Sapienza, Roma, Italia.
authors.forename: Salciccia
authors.initials: S
authors.lastname: Stefano
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D061646:Operative Time; D009929:Organ Size; D011183:Postoperative Complications; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D015203:Reproducibility of Results; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000517:prevention & control / Q000534:rehabilitation