Posterior reconstruction was found to be associated with lower degree of anastomotic leakage and enhanced urinary continence at one and three months after extrafascial laparoscopic radical prostatectomy.
To detail the technique and evaluate the impact of a personal modified posterior reconstruction technique (PDR) on the outcomes of extrafascial laparoscopic radical prostatectomy (eLRP) in a consecutive series of 52 patients affected by high-risk prostate cancer (HRPCa).
From October 2007 to March 2012, 52 patients underwent PDR during eLRP for HRPCa. Fifty-four patients who underwent eLRP for HRPCa with no PDR were considered as historical controls. Mean operative time (MOT), mean catheterization time (MCT), % continence and quality of life (QoL) at a scheduled follow-up, % anastomotic leakage, % adjuvant therapy were compared between the groups. Percentage of continence and QoL were prospectively assessed by self-administered validated questionnaires (ICI-Q-SF; SF-36) at 1, 3, 6, and12 months.
PDR was associated wither higher continence rates at 1 and 3 mo ( P = .028, P = .006), a lower incidence of cystographic leakage ( P = .002), and an increased adjuvant radiotherapy rate ( P = .008). At 1- and 3-mo interval, in the PDR group, we found a higher number of patients reporting better general health, ( P = .01, P = .03) reduced role limitations due to physical health, ( P = .02, P = .001), and emotional problems ( P = .001, P = .02).
PDR is associated with a lower degree of anastomotic leakage, and it significantly enhances urinary continence at 1 and 3 mo. The increased adjuvant radiotherapy rate and quality of life after surgery observed with our technique suggest that in the high-risk setting an early functional recovery may substantially influence the oncologic outcome of eLRP.