NEW ORLEANSTransperitoneal laparoscopic radical prostatectomy achieves negative surgical margins comparable to those achieved with the open retropubic approach, according to a study from University of Massachusetts Medical School investigators. They reported their results at the American College of Surgeons 87th Clinical Congress.
The reproducibility of laparoscopic prostatectomy has already been demonstrated in several large series, and a number of theoretical advantages have been suggested: improved surgical visualization, decreased operative morbidity, and increased cosmesis.
However, to justify the adoption of this new technique as a cancer operation, it is important to show that adequate surgical margins can be achieved in a reproducible manner, said Vernon Pais, Jr., MD, of the Division of Urology, Department of Surgery.
"There have been several major obstacles to more widespread acceptance," he said. "One is the so-called steep learning curve. Many have questioned the utility of developing a technically challenging alternative to what is a well-tested, established, and reproducible procedure at which most urologic surgeons are quite well trained." Another issue is that the procedure remains unproven. "There is very limited experience and no long-term follow-up," he said.
Dr. Pais shared the experience at his institution, where about 70 laparoscopic prostatectomies have been performed to date. The research team compared the surgical margins of 37 consecutive patients undergoing laparoscopy with those of the most recent 37 patients undergoing open procedures. The same surgeons performed all the procedures.
Any specimen in which tumor extended to the margin was considered to represent a positive surgical margin.
Dr. Pais reported there was no evidence of cancer at the surgical margins in 33 of the 37 laparoscopic patients (89%), and in 29 of the 37 patients undergoing the open approach (78%). Overall, the positive surgical margin rate, therefore, was 11% in the laparoscopic group and 22% in the open prostatectomy group.