Journal Article

Retrograde Extraperitoneal Laparoscopic Prostatectomy (RELP). A Prospective Study about 1,000 Consecutive Patients, with Oncological and Functional Results

Chaffange, Pierre, Ficheur, Grégoire, Vaziri, Nader, Dubernard, Pierre, Pacheco, Philippe, Chazard, Emmanuel, Pricaz, Elie, Vinet, Maxime, Chalabreysse, Philippe, Rochat, Charles-Henry

2021

Overview

Usual laparoscopic surgery of localized prostate cancer uses antegrade dissection. We describe and evaluate the original RELP (Retrograde Extraperitoneal Laparoscopic Prostatectomy). A prospective cohort of 1005 patients with clinical localized cancer prostate were operated from December 1999 to September 2013, in Lyon (France), and followed up to 172 months (median: 60 months). Patients encountered a RELP procedure, a totally extra-peritoneal approach with a retrograde dissection from the apex to the bladder neck, and ascending dissection of the erectile neurovascular bundles, facilitated by the 30° optic telescope. Adjunctive treatments were: immediate radiotherapy (9.2%), salvage radiotherapy (13.4%), androgen deprivation therapy (10.8%), chemotherapy (1.4%), no treatment (75.8%). Results The mean age was 63.4, the Gleason score was 4+3 or worse in 24.9%, there were 2.3% unifocal tumors. The pathology stages were pT2A (8.71%), pT2B (2.80%), pT2C (69.0%), pT3A (13.1%), and pT3B (6.41%). There were 60.8% negative margins (R0) in total (90.1% for basal locations, and 75.8% for apical locations). The mean operating time was 115 minutes for the last 100 patients. The BPFSR (biological progression free survival rate, PSA≤0.10 ng/ml) was 71.9% at 5 years, and 61.4% at 10 years. The cancer specific survival rate was 99.4% at 5 years, and 98.3% at 10 years. After 12 months, 88.6% of patients did not require an incontinence pad, and 67.0% retained the pre-operative quality of their erection. RELP yields good oncologic results and quality of life, as good as robot-assisted surgery.

• Publisher: Urology and Nephrology Research Center
• Subject: Androgen Antagonists / Cancer surgery / Cancer therapies / Chemotherapy / Dissection / Humans / Laparoscopy / Life Sciences / Male / Middle Aged / Prospective Studies / Prostate cancer / Prostatectomy / Prostatic Neoplasms - surgery / Quality of Life / Radiation therapy / Treatment Outcome / Urological surgery