The factors influence the pentafecta outcomes post laparoscopic radical prostatectomy in asia
Henry Y. Lin1, Yu-Chi Chen1 , Hua-Pin Wang1 , Chao-Yang Jiang1, Hung-Yu Lin1, Kevin Lu1, Ching-Yu Huang1, Tsan- Jung Yu1,2 ,Victor C. Lin1,2
1 Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
2 School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
In men with localized prostate cancer, radical prostatectomy (RP) was the choice of treatment. The outcomes post RP are usually use the trifecta which included cancer free and full functional recovery but this does not cover all aspects of surgery. Pentafecta is a more comprehensive methodology to report outcomes after radical prostatectomy, including complications and surgical margin status with the three major outcomes classically reported. The purpose of this study is to report our experience with laparoscopic radical prostatectomy (LRP) by applying the concept of pentafecta.
Materials and Methods:
From May 2008 through May 2014, details of 180 consecutive patients who underwent laparoscopic radical prostatectomy performed by a single surgeon were retrospectively analyzed. Among these patients, 54 patients reported good sexual function before surgery underwent unilateral or bilateral nerve sparing and had at least 1 year of follow-up were included in the study group.
The average age was 66.3 ± 8.2 years (49–79) and the total PSA was 13.83 ± 8.10 ng/dl (2.094- 40 ng/dl). According to D’Amico classification, 10 persons (18.5 %) were low; 25 persons (46.3%) were median, and 19 persons (35.2%) were high. The operative time was 183.8± 81.6 min (65-52.5), and the complication rate was 18.5 % in Clavien I–II (10) and 1.9 % in Clavien III(1 laceration over urethovesical anastamosis). The positive surgical margins was 20.4% (11/54); the biochemistry recurrence was 20.4 % (10/ 49 12~72 months); the continence rate was 96.3 % and the potency rate was 66.7 %. The trifecta rate and pentafecta rate were 59.3 % and 40.7 % in the follow-up and became 73.5% and 58.8 % after excluding the advanced pathology stage (pT >2) and old age (age > 70 year-old) patient.
The pentafecta is an ideal condition for comprehensive approach for reporting prostate surgery outcomes after radical prostatectomy in early stage prostate cancer. Because older age and advanced stage of patients in Asia, it is not feasible to predict the outcomes of prostate cancer treated with laparoscopic radical prostatectomy. This approach may be beneficial and may be used when counseling for those younger patients with clinically localized prostate cancer.