Open RP feasible for prostate patients with previous hernia repair
MedWire News: Open radical retropubic prostatectomy (ORP) is a feasible option for prostate cancer patients who have had previous laparoscopic inguinal hernia repair (LIHR) with mesh, US researchers report.
Previous studies have shown that the prosthetic mesh used in LIHR can cause complications during prostate surgery because of its often extensive coverage and fibrotic response, thus compromising the safety of dissection of pelvic structures.
In spite of this, Daniel Saint-Elie and Fray Marshall (Emory University, Atlanta, USA) report that “ORP with pelvic lymphadenectomy (LAD) after LIHR with mesh can typically be performed with minimal risks and in carefully selected patients for best outcomes.”
They do note a compromise in the success of LAD staging among men with LIHR during ORP, however.
The researchers’ experiences of ORP in a cohort of 949 men, 21 of whom had previous LIHR (13 unilateral and eight bilateral), revealed minimal complications, with a mean estimated blood loss of 657 ml, and a mean operative time of 178 minutes. The mean number of pelvic lymph nodes removed was 10.4 compared with 8.6 among a control cohort of men undergoing ORP with no previous LIHR.
Pre-operatively, 18 and three men had clinical stage T1c and stage T2a cancer, respectively, while postoperatively, four, four, 11, and two men had stage T2a, T2b, T2c, and T3a disease, respectively.
A total of 15 men were able to undergo pelvic LAD for staging purposes, three men with bilateral LIHR compared with 12 men with unilateral LIHR. However, six men had fibrosis at the mesh site severe enough not to permit LAD.
Saint-Elie and Marshall report that prior bilateral mesh repair made dissection during ORP more challenging than with unilateral mesh, and men with bilateral LIHRs were less likely to be able to undergo pelvic LAD.
“Patients with previous LIHR should be informed that the quality of their staging pelvic LAD might be compromised by previous LIHR, but not the resection of the prostate,” write the researchers.
They conclude: “As urologists perform more ORPs after, and as general surgeons utilize less mesh more judiciously, we anticipate easier execution of ORP after LIHR.”
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By Sarah Guy