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Early outcome assessment of laparoscopic radical prostatectomy - 1


MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HO CHI MINH CITY UNIVERSITY OF MEDICINE AND PHARMACY


NGUYEN TIEN DE

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EARLY RESULTS EVALUATION OF EXTRAPERITONOUS LAPAROSCOPIC SURGERY

Early outcome assessment of laparoscopic radical prostatectomy - 1

RADICAL PROSTATectomy


Specialty: Nephrology and Urology Code: 62720126


DOCTORAL THESIS IN MEDICINE


Scientific supervisor : Associate Professor, Dr. VU LE CHUYEN


Ho Chi Minh City - 2015


COMMITMENT


I hereby declare that this is my own scientific research work. The data and results in the thesis are honest and have not been published in any other work.


Thesis author


Nguyen Tien De



Cover Page Pledge Table of Contents

List of abbreviations English - Vietnamese list

INDEX


Page

List of tables, charts, figures

PROBLEM STATEMENT 01

Chapter 1: DOCUMENT OVERVIEW 03

1.1. Anatomy 03

1.2. Diagnosis of localized cancer 07

1.3. Diagnosis of cancer stage 11

1.4. Prediction of results before surgery 13

1.5. Treatment 15

Chapter 2: RESEARCH OBJECTS AND METHODS 31

2.1. Research subjects 31

2.1.1. Patient selection criteria 31

2.1.2. Exclusion criteria 31

2.2. Research methods 32

2.3. Steps to follow 32

2.4. Evaluation of treatment results 39

2.5. Data collection and processing 42

2.6. Medical ethics 43

Chapter 3: RESEARCH RESULTS 44

3.1. Clinical results 44

3.2. Paraclinical results 47

3.3. Treatment results 56

3.4. Evaluation of treatment results 72

3.5. Verifying factors affecting treatment outcomes 76

Chapter 4: DISCUSSION 83

4.1. Discussion of treatment 83

4.2. Analysis of failed laparoscopic surgery cases 110

4.3. Analysis of biochemical recurrence cases 112

4.4. Evaluation of treatment results 114

4.5. Discussion of factors affecting treatment outcomes 117

CONCLUSION 123

PROPOSAL 124

LIST OF AUTHOR'S RESEARCH WORKS REFERENCES

Appendix 1: Sample medical record

Appendix 2: List of patients studied at the Department of Urology-C, Binh Dan Hospital Appendix 3: TNM cancer staging table according to NCCN

Appendix 4: Assessment of urinary incontinence status based on ICIQ questionnaire Appendix 5: Estimated average life expectancy

Appendix 6: Partin cancer invasiveness prediction table


LIST OF ABBREVIATIONS


FULL ABBREVIATION

Patient

GPB Pathology

K Cancer

P Yes

PM Peritoneum

PT Surgery

PTNS Laparoscopic surgery

PTV Surgeon

RLC Erectile Dysfunction

Ultrasound

T Left

TH Case

Urinary incontinence

Prostate TTL


ENGLISH - VIETNAMESE TERMINOLOGY


ENGLISH VIETNAMESE

Active surveillance Active monitoring

Biochemical recurrence Biochemical recurrence

Bone scintigraphy

Computed tomography scan

Digital rectal examination Digital rectal examination

Dorsal venous complex Dorsal venous plexus (penis)

Erectile dysfunction Erectile dysfunction

Extraperitoneal LRP approach PTNS resected the TTL beyond the PM Gleason score Gleason score

Hormone therapy Hormone therapy

Localized prostate cancer Laparoscopic lymph node dissection Laparoscopic lymph node dissection

Laparoscopic radical prostatectomy PTNS Magnetic resonance imaging Magnetic resonance imaging

Monoclonal-antibody- TTL scintigraphy with monoclonal anti-body radioimmunoscintigraphy (MAR) Neurovascular bundle Neurovascular bundle preservation Open radical prostatectomy Open radical prostatectomy

Positive margin Surgical margin

Prostate-specific antigen (PSA) Prostate-specific antigen (PSA) Radiation therapy


Radical retropubic prostatectomy Open radical prostatectomy

behind pubic bone

Rising PSA level Rising PSA level

Screening for prostate cancer Screening for prostate cancer Striated urethral sphincter Striated urethral sphincter

Transrectal ultrasound prostate biopsy SA, Transperitoneal LRP approach PTNS radical prostatectomy via PM Tumor marker Cancer marker

Urinary incontinence


LIST OF TABLES


Page

Table 2.1. Assessment of erectile dysfunction 41

Table 3.2. Medical history 45

Table 3.3. Associated internal diseases 45

Table 3.4. Rectal examination to detect prostate cancer 46

Table 3.5. Estimated TTL volume by rectal examination 46

Table 3.6. Lesions detected on transrectal ultrasound 48

Table 3.7. Gleason scores from 50 biopsy samples

Table 3.8. Cancer differentiation through biopsy samples 51

Table 3.9. Other pathologies detected by general abdominal ultrasound 51

Table 3.10. CT scan results 52

Table 3.11. Magnetic resonance imaging results 53

Table 3.12. Bone scintigraphy results 54

Table 3.13. Classification of cancer stages before PT 55

Table 3.14. Urinary incontinence status before PT 55

Table 3.15. Erectile dysfunction status before PT 56

Table 3.16. Comparison between two surgical methods 57

Table 3.17. Pelvic lymph node dissection 57

Table 3.18. Rate of laparoscopic surgery failure, conversion to open surgery 58

Table 3.19. Retrograde and anterograde endoscopic prostatectomy 59

Table 3.20. Neurovascular preservation surgery 60

Table 3.21. Bladder-urethral neck anastomosis technique 60

Table 3.22. Comparison of surgical time between the two groups 62

Table 3.23. Blood loss in PT 63

Table 3.24. Comparison of blood loss between the two groups 64

Table 3.25. Pathological results of pelvic lymph nodes 66

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