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Die endoskopische extraperitoneale radikale Prostatektomie (EERPE)

Ergebnisse nach 300 Eingriffen

Endoscopic extraperitoneal radical prostatectomy

Results after 300 procedures

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Zusammenfassung

Laparoskopische Techniken haben sich in den letzten Jahren für eine wachsende Anzahl von Eingriffen und Indikationen in der Urologie etabliert. Die laparoskopische, radikale Prostatektomie (LRPE) ist trotz ihrer anspruchsvollen Technik und der damit verbundenen Lernkurve in zahlreichen Zentren zu einem festen Bestandteil in der Behandlung des klinisch lokal begrenzten Prostatakarzinoms geworden. Kritisch diskutiert wird häufig der transperitoneale Zugang zu dem extraperitonealen Organ Prostata, mit den damit verbundenen potenziellen intraperitonealen Komplikationen.

Die endoskopisch-extraperitoneale radikale Prostatektomie (EERPE) ist eine Weiterentwicklung der minimal-invasiven radikalen Prostatachirurgie, die diese Limitationen der LRPE umgeht. Die operative Technik wurde im Verlauf unserer wachsenden Erfahrung kontinuierlich weiterentwickelt, einschließlich der Etablierung einer nervenschonenden, potenzerhaltenden Technik (nEERPE).

Wir können mittlerweile über ein Kurzzeit-Follow-up nach 300 Eingriffen berichten. Die mittlere Operationszeit betrug 115 min ohne und 150 min mit Lymphadenektomie, insgesamt 140 min (60–260 min). Eine Konversion war in keinem Fall notwendig. Die Transfusionsrate betrug 1,3%. Es waren 3 frühe Reinterventionen (2-mal Nachblutung, 1-mal Hämatom) und 5 späte Reinterventionen (4 symptomatische Lymphozelen, 1 Kolostomie bei rektourethraler Fistel) notwendig.

Histologisch wurden folgende Tumorstadien diagnostiziert: pT2a bei 54 Patienten (18%), pT2b bei 87 Patienten (29%), pT3a bei 115 Patienten (38,3%), pT3b bei 40 Patienten (13,3%) und pT4 bei 4 Patienten (1,3%). Positive Absetzungsränder lagen bei 13/141 Patienten (9,2%) mit einem pT2-Tumor, und 47/155 Patienten (30,3%) mit einem pT3 Tumor vor.

Die mittlere Katheterverweildauer betrug 6,9 Tage. 6 bzw. 12 Monate postoperativ waren 86,3% bzw. 89,6% der Patienten komplett kontinent, und jeweils 9,2% der Patienten benötigten 1–2 Vorlagen pro Tag. 4,5 bzw. 1,2% der Patienten benötigten mehr als 2 Vorlagen täglich.

Die frühen onkologischen und funktionellen Ergebnisse der EERPE sind im Vergleich zur LRPE zumindest gleichwertig, bei deutlich kürzeren Operationszeiten und einer insgesamt niedrigen Komplikationsrate. Die EERPE verbindet die Vorteile eines total extraperitonealen Zugangs mit denen der Minimalinvasivität der Laparoskopie.

Abstract

During the last decade laparoscopy has become the standard technique in the urologist’s armamentarium due to constant technological advancements and refinements. Laparoscopic radical prostatectomy (LRPE), although technically demanding and associated with a considerable learning curve, has become the operative procedure of choice for patients with clinically localized prostate cancer in selected and specialized urologic centers around the globe. However, a major drawback of LRPE is the transperitoneal route of access to the extraperitoneal organ of the prostate. The principal disadvantages of LRPE are potential intraperitoneal complications. Endoscopic extraperitoneal radical prostatectomy (EERPE) is a further advancement of minimally invasive surgery as it overcomes the limitations of LRPE by the strictly extraperitoneal route of access.

Based on our growing experience with this procedure we introduce several technical modifications, improvements, and refinements including a nerve-sparing, potency-preserving approach (nEERPE) in an effort to further improve this minimally invasive procedure.

We report our short-term follow-up results after 300 procedures. The mean operative times were 115 min without and 150 min with lymph node dissection, in total 140 min (range: 60–260 min). There was no conversion and the transfusion rate was 1.3%. There were three early reinterventions (two bleeding and one hematoma) and five late reinterventions (four symptomatic lymphoceles and one colostomy due to a rectal fistula).

Pathological stage was pT2a in 54 patients (18%), pT2b in 87 patients (29%), pT3a in 115 patients (38.3%), pT3b in 40 patients (13.3%), and pT4 in 4 patients (1.3%). Positive surgical margins were found in 9.2% (13/141) of patients with pT2 tumor and 30.3% (47/155) of patients with pT3 tumor. The mean catheterization time was 6.9 days. Six and twelve months postoperatively 86.3 and 89.6% of the patients were completely continent; 9.2% of patients needed 1–2 pads per day and 4.5 and 1.2% of patients needed more than 2 pads per day, respectively.

Short-term oncological and functional results of EERPE are at least as favorable as in LRPE while operative times are shorter and complication rates are low. EERPE is a technical advancement because it combines the advantages of a totally extraperitoneal access with the advantages of a minimally invasive procedure.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig

    J.-U. Stolzenburg, R. Rabenalt, M. Do, H. Pfeiffer, A. Bekos, J. Neuhaus, U. Jonas & W. Dorschner

  2. Klinik und Poliklinik für Urologie und Kinderurologie, Medizinische Hochschule Hannover

    M. C. Truss & C. G. Stief

  3. Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig

    J.-U. Stolzenburg

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  1. J.-U. Stolzenburg
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  2. M. C. Truss
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  3. R. Rabenalt
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  4. M. Do
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  5. H. Pfeiffer
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  6. A. Bekos
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  7. J. Neuhaus
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  8. C. G. Stief
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  9. U. Jonas
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  10. W. Dorschner
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Correspondence to J.-U. Stolzenburg.

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Stolzenburg, JU., Truss, M.C., Rabenalt, R. et al. Die endoskopische extraperitoneale radikale Prostatektomie (EERPE). Urologe [A] 43, 698–707 (2004). https://doi.org/10.1007/s00120-004-0561-2

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