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Minerva Chirurgica 2018 Apr 13

DOI: 10.23736/S0026-4733.18.07759-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Extrafascial robot-assisted laparoscopic radical prostatectomy (EF-RALP) in locally advanced prostate cancer

Vito PANSADORO, Aldo BRASSETTI

Department of Urology, Fondazione Vincenzo Pansadoro, Centro di Urologia Laparoscopica e Oncologia Medica, Rome, Italy


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INTRODUCTION: Up to 26.5% of new dewly diagnosed prostate cancers (PCa) are locally advanced (LA). Although traditionally discouraged in this setting, radical prostatectomy (RP) lowers the risk of metastatic progression and cancer-specific death. We report a review of the available evidences and describe our surgical technique of Extrafascial robot-assisted RP.
EVIDENCE ACQUISITION: The PubMed/Medline database was searched for “prostate cancer”, “high-risk”, “locally advanced”, “prostatectomy”. Duplicates and expert opinion papers were removed.
EVIDENCE SYNTHESIS: RP is an option in selected patients with LA-PCa and >10 years life expectancy. Five, 10 and 15 years after open RP, disease free survival rates were 85%, 73% and 67%. At the same time-points, cancer specific survival and overall survival were 95%, 90%, 79% and 90%, 76%, 53%, respectively. Post-operative potency was achieved by 25% of the patients while 79% were continent. Robotic prostatectomy provides comparable cancer control outcomes, but it is associated with a lower transfusion rate and a shorter hospitalization time. The concept of “extrafascial prostatectomy” was introduced in 2000 by Villers: this surgical approach reduces the incidence of mid- and postero-lateral positive margins (28% vs 51%, when compared to intrafascial; p = 0.08), expecially in pT3 cancers, but markedly affects potency.
CONCLUSIONS: Robot-assisted RP is an option in patients with LA-PCa. Removing the prostate gland and the seminal vesicles still contained inside their aponeurotic covering, minimize the risk of positive surgical margins and clinical recurrence.


KEY WORDS: Locally advanced prostate cancer - Robotic - Prostatectomy - Positive surgical margins - High risk prostate cancer

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Publication History

Article first published online: April 13, 2018
Manuscript accepted: April 10, 2018
Manuscript received: March 31, 2018

Per citare questo articolo

Pansadoro V, Brassetti A. Extrafascial robot-assisted laparoscopic radical prostatectomy (EF-RALP) in locally advanced prostate cancer. Minerva Chir 2018 Apr 13. DOI: 10.23736/S0026-4733.18.07759-3

Corresponding author e-mail

aldo.brassetti@gmail.com