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01.12.2012 | Technical innovations | Ausgabe 1/2012 Open Access

World Journal of Surgical Oncology 1/2012

Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection

Zeitschrift:
World Journal of Surgical Oncology > Ausgabe 1/2012
Autoren:
Eijiro Okajima, Motokiyo Yoshikawa, Yasumasa Masuda, Kazuhiro Shimizu, Nobumichi Tanaka, Akihide Hirayama, Keiji Shimada, Kiyohide Fujimoto, Yoshihiko Hirao
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1477-7819-10-249) contains supplementary material, which is available to authorized users.

Competing interest

The authors declare that they have no competing interest.

Authors’ contributions

EO designed the study, acquired data, controlled the quality of the procedure as either operator or assistant during surgery for all 90 cases, carried out analysis and interpretation of data, and drafted the manuscript. MY, YM, AI and KaS contributed to the acquisition of data and participated in the surgery as either operator or assistant during some surgeries. HK contributed to the acquisition of data. NT and AH participated in the study design, contributed to the acquisition of data, participated in the surgery as either operator or assistant during some surgeries, and helped to draft the manuscript. KeS made the pathological diagnoses. KF and YH participated in the study design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Retropubic radical prostatectomy with intentional wide resection (RRP-WR), which enables clear location of the prostate apex and the performance of posterolateral wider resection to remove extraprostatic extension, was introduced to our institutions. The aim of this study is to assess the feasibility and the efficacy of RRP-WR as a surgical intervention for locally confined prostate cancer.

Methods

A total of 90 Japanese patients with pathologically proven and clinically locally confined hormone-naïve prostate cancer were treated through RRP-WR, and the surgical morbidity was assessed. The patients were observed without immediate treatment until biochemical recurrence (BCR).

Results

The surgical morbidities were comparable to conventional procedures. No positive surgical margin (pSM) was pathologically identified in pT2 cases from prostatectomy specimens. It was identified in only 14.3% of pT3a cases, 36.4% of pT3b cases and 100% of pT4 cases. No apical pSM was found except for one of the pT4 cases in the levator ani muscle. PSA was at an undetectable level in 80.0% of all cases, 90.0% of pT2 cases, and 67.5% of pT3 and pT4 cases after surgery. The BCR-free survival rate in all cases was 82.4% and that of high-risk cases without pSM was 76.9% at a median follow-up of 19.3 months (3.3 to 59.2).

Conclusions

RRP-WR is feasible and effective in removing organ-confined prostate cancer as well as extraprostatic extension without pSM. Thus, it is worthwhile to evaluate if this procedure improves the clinical outcome of locally confined prostate cancer including high-risk conditions treated by surgical intervention.
Zusatzmaterial
Authors’ original file for figure 1
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Authors’ original file for figure 2
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Authors’ original file for figure 3
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Literatur
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