Laparoscopic RP Safe for Elderly

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But it has a higher incontinence rate, study says .
 
Extraperitoneal laparoscopic radical prostatectomy (eL-RPE) is feasible and efficacious in elderly patients with localized prostate tumors, according to German researchers.

They retrospectively studied 204 men who underwent eL-RPE. These men were divided into two groups by age: 71 years and older (eL-RPE1; 72 patients) and 59 years and younger (eL-RPE2; 132 patients).

The researchers, led by Vassilis Poulakis, MD, of Nordwest Hospital in Frankfurt am Main, also compared the eL-RPE1 group with a comparable group of 70 men aged 71 and older who underwent open retropubic radical prostatectomy. These two groups had similar pathologic and Gleason scores.

Compared with the eL-RPE2 group, the el-RPE1 patients had a higher pathologic stage and higher Gleason score, Dr. Poulakis and his colleagues reported in European Urology (2007;51:1341-1349). Operative time, analgesic requirements, hospital stay, convalescence, and complication rates were similar, but the urinary incontinence rate at six months was higher in the older group than in the younger patients (91% vs. 67%).

The el-RPE1 patients and the open surgery group had similar operative times, but the former had less blood loss, shorter hospital stays, and more rapid convalescence. The mean intraoperative estimated blood loss was 205 mL in the eL-RPE group and 486 mL in the open surgery group.

The mean hospital stay was nine days and 11 days, respectively. The el-RPE1 group required a mean 39 days for full recovery compared with 61 days for the open surgery group. The urinary incontinence rate at six months was 70% in the open surgery patients, but this was not statistically lower than the rate in the eL-RPE1 group.

“Both techniques offer similar functional and oncologic results in the elderly,” the authors wrote. “However, the observed higher in-continence rate in the elderly should be discussed preoperatively.”
 
The investigators concluded that it is “safe and probably more reasonable to offer carefully selected elderly patients an eL-RPE because chronological age, per se, is not a contraindication for a laparoscopic approach” for treating localized prostate tumors.
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