Clinical review of patients who underwent laparoscopic radical prostatectomy（LRP）after neoadjuvant hormonal therapy

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  • neoadjuvant hormonal therapy併用腹腔鏡下前立腺全摘除術（LRP）症例の臨床的検討
  • neoadjuvant hormonal therapy ヘイヨウ フククウキョウ カ ゼンリツセン ゼンテキジョジュツ(LRP)ショウレイ ノ リンショウテキ ケントウ

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Abstract

Purpose：In our hospital, neoadjuvant hormonal therapy（NHT）has been performed before surgery to achieve down-staging of high-risk patients and reduce the prostatic volume. In this study, we clinically reviewed patients who underwent laparoscopic radical prostatectomy after NHT. <br>  Materials and Methods：The subjects were 30 patients who underwent this procedure between June 2012 and May 2014, with a mean age of 65.3 years in the NHT group and 68.3 years in the non-NHT group. The mean iPSA level was 10.8 and 10.7 ng/mL, respectively. The mean preoperative prostatic volume was 24.3 and 30.6 mL, respectively. The mean NHT period was 8.27 months. The clinical stage was evaluated as cT1c in 14 patients, cT2 in 8, and cT3 in 8. GS was 6 or lower in 9 patients, 7 in 12, and 8 or higher in 9. For surgery, retroperitoneal/ anterograde approaches were used in all patients. After the posterior wall was reinforced, vesicourethral anastomosis was performed using Biosyn™（continuous suture）and Lapra-Ty™. <br>  Results：The mean duration of surgery was 208.2 and 201.8 minutes in NHT and non-NHT groups, respectively. The mean volume of blood loss was 573.5 and 600.4 mL, respectively. The mean catheterization period was 5.3 and 5.9 days, respectively. Histological treatment responses were assessed in the NHT group. The grade was evaluated as 0b in 3 patients, 1 in 3, 2 in 4, and 3b in 11. Two patients（6.7%）had a positive resection margin（RM）. <br>  Conclusion：In high-risk patients, the proportion of those with favorable histological responses to NHT was relatively high. Furthermore, there were no differences in the duration of surgery or volume of blood loss between NHT and non-NHT groups. The proportion of stump tumor cell-positive patients was low.

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