Development of "extended radical retropubic prostatectomy": a surgical technique for improving margin positive rates in prostate cancer.

ABSTRACT

AIMS: The objective of this study was to introduce a surgical approach called "extended radical retropubic prostatectomy (ERRP)" developed to reduce positive surgical margin rates in prostate cancer. METHODS: Modified surgical procedures in ERRP included apical dissection (division of the dorsal venous complex far distal to the prostatic urethral junction), excision of the bilateral neurovascular bundles (wide resection of structure between the exterior of the urethra and the rectal surface, which contains the neurovascular bundle), perirectal dissection (complete resection of perirectal tissue by dissecting the anterior rectal surface until the muscle layer of the rectum was encountered) and seminal vesicle excision (dissection that leaves seminal vesicles protected by Denonvilliers' fascia with the surrounding fatty and fascial coverings without pulling seminal vesicles from the prostate). This study included 127 consecutive patients who did not request the preservation of potency and underwent ERRP without any neoadjuvant therapies. RESULTS: Median value of preoperative serum prostate specific antigen in 127 patients was 18.1 ng/ml. Median operative time and estimated blood loss in these patients were 209 min and 744 ml, respectively. The pathological stage was diagnosed as pT2, pT3a, pT3b and pT4 in 51, 52, 20 and 4, respectively, while positive surgical margin was detected in 14 of the 127 patients. Furthermore, during the observation period of this study (median, 46 months), biochemical recurrence was detected in 11 of the 127 patients. CONCLUSIONS: The ERRP technique could successfully decrease the positive surgical margin rate even in patients with comparatively adverse disease characteristics.