Endoscopic Extraperitoneal Radical Prostatectomy (EERPE): A New Approach for Treatment of Localized Prostate Cancer
Sittiporn Srinualnad MD, FRCS*, Chaiyong Nualyong MD *, Suthipol Udompunturak MS **, Wanvimol Kongsuwan MNS***
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University ** Clinical Epidemiology Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University *** Perioperative nursing Division, Nursing Department, Faculty of Medicine Siriraj Hospital, Mahidol University
Laparoscopic radical prostatectomy is usually performed by transperitoneal approach. Patients
may encounter, intraperitoneal organs injury, and prolonged ileus during recovery period. The authors firstly
performed endoscopic extraperitoneal radical prostatectomy (EERPE) in Thailand, which is mimicking open
radical prostatectomy, the gold standard for treatment of localized prostate cancer.
Objective : Assess and evaluate the feasibility and early outcomes of the authors’ experience in endoscopic
extraperitoneal laparoscopic radical prostatectomy (EERPE).
Materials and Methods : From December 2005 to May 2006, 27 cases of EERPE were performed at the authors’
institute for clinically localized prostate cancer by one surgeon (group I). Operative data was compared to those
55 patients who underwent open radical prostatectomy from February 2001 to August 2005 for early prostate
cancer by the same surgeon (group II). Early postoperative results, clinical outcomes and complication were
analyzed between the two groups using Chi-Square, student unpaired t-test and Mann-Whitney U tests.
Results : Patients’ age and clinical staging were not different between the two groups. Mean operative time
was longer in the EERPE group (268 minutes vs 157 minutes; p < 0.01). Median blood loss was 500 mls and
1000 mls in the EERPE and open groups, respectively (p < 0.001). The likelihood of transfusion rate in the
open group was higher than the EERPE group, with odd ratio of 8.75 (95%CI = 2.09-39.86), p = 0.001.
Hospitalization time and pathological stage were not different between the two groups. In the EERPE group,
there were two rectal complications, including rectal injury and rectal necrosis, which were treated
laparoscopically and conservatively without long-term problems.
Conclusion : The authors’ early experience has shown that EERPE is feasible. Although operative time was
longer, the patients may gain benefit of minimally invasive surgery and decreased operative blood loss. In
EERPE group, oncological outcomes are equal to open surgery, however, more cases and long-term follow up
are required to evaluate the efficacy of such an approach.
Keywords : Endoscopic extraperitoneal radical prostatectomy, Prostate cancer, Laparoscopy
