THE CLOSER PROGRAMME - INITIAL EXPERIENCE WITH LAPAROSCOPIC VERSUS OPEN RADICAL PROSTATECTOMY

REZUMAT Introduction and objectives: The prostate-specific antigen (PSA) screening has brought about an increase in the diagnosis of localized forms of prostatic cancers. We set out to assess the results of the first 108 radical prostatectomies (both laparoscopic and classical) performed as a result of the CLOSER screening programme. Materials and methods: More than 10,000 men over 50 years of age cancer were evaluated in the CLOSER programme between March 2005 and March 2009. As a result of this programme, 315 patients were found to have prostatic cancer, 45% in a localized form. The latter underwent radical surgical treatment; 108 radical prostatectomies were performed (58 laparoscopic, 50 open), the rest being included in a radiotherapy programme. Results: The mean age of the patients was 63 years (range 50 to 70 years), and the mean PSA value was 8.9 ng/ml (range 1.7-33 ng/ml). A number of 28 patients were staged clinically as T1c, 69 as T2, 11 as T3. The positive margin rate was 10/58 for the laparoscopic and 9/50 for the classical interventions. From the oncological point of view, a PSA<0.2 ng/ml was obtained in 41 laparoscopic and 45 respectively classical prostatectomies. The assessment of the partial functional results showed a 63% preservation of continence in laparoscopic patients and 78% respectively, for classical surgery patients respectively. Conclusion: Laparoscopic radical prostatectomy remains the surgical technique with the least hemorrhagic complications as compared to the classical one, even when assessed on small groups of patients. The difficulties of laparoscopic anastomosis impose a longer indwelling catheter time, at the beginning of the learning curve, at least.