Twenty-Year Single Surgeon Experience with Radical Perineal Prostatectomy: Oncologic, Functional Outcomes and Perioperative Complications

ABSTRACT

PURPOSE: To evaluate oncologic, functional outcomes and complications in patients with prostate cancer (PCa) who underwent radical perineal prostatectomy (RPP). MATERIALS AND METHODS: A retrospective review of patients who underwent RPP by a single surgeon between 1995 and 2014 was performed. We analyze clinicopathologic characteristics and postoperative complications including urinary continence and erectile function. Kaplan-Meier survival analysis was used to access biochemical recurrence (BCR)-free survival (BFS) and cancer-specific survival (CSS) and log-rank test was applied. Complications were stratified by the Clavien-Dindo classification system. RESULTS: A total of 816 patients were included in this study. The mean prostate-specific antigen and prostate volume was 8.89 ng/mL and 30.8 mL. Positive surgical margin was identified in 174 patients (21.3%) after RPP. During a mean follow-up of 58.7 months, 173 patients (21.2%) experienced BCR. Overall, 44 patients (5.4%) died, of which 15 (1.8%) died from PCa. The 5-year BFS in patients with T2, T3a, and T3b were 84.8%, 69.7%, and 46.7% (p<0.001), respectively. The 10-year CSS in patients with same groups were 98.9%, 98.2%, and 79.5% (p<0.001), respectively. At 12 months after RPP, recovery of urinary continence and erectile function was identified in 88.3% and 63.7% of patients. Wound dehiscence (8.9%) was the most common complication. However, approximately 78% of complications were grade I or II. CONCLUSIONS: Our study indicates that RPP shows acceptable outcomes in terms of oncologic results and complications in patients with PCa. Careful attention is required to prevent wound dehiscence.