COMPARISON OF LAPAROSCOPIC AND MINILAPAROTOMY PELVIC LYMPHADENECTOMY FOR PROSTATE-CANCER STAGING IN A COMMUNITY PRACTICE

Objectives. To compare the cost-effectiveness and morbidity of minilap arotomy (MINILAP) and laparoscopic pelvic lymphadenectomy (LAP) in a c ommunity practice setting. Methods. We reviewed our experience with 44 consecutive patients with prostate cancer who had staging pelvic lymp hadenectomy from January 1992 through April 1995 in a general health m aintenance organization urology practice. Of this group, 22 men had LA P and 22 men had MINILAP. Results. MINILAP and LAP groups were similar in age (mean 67 years), Gleason score (mean 7.2 and 6.8), prostate-sp ecific antigen level (mean 46 and 49 ng/mL), and clinical stage (TI to T3). Operative time was statistically significantly shorter for MINIL AP (mean 1.2 hours) than for LAP (mean 2.9 hours). Complication rate w as 9.1% for MINILAP and 31.8% for LAP. Lymph node metastasis was found in 45% of MINILAP patients and in 27% of LAP patients. Mean initial h ospital stay was 1.0 day for MINILAP and 1.6 days for LAP. Total hospi tal stay including hospital readmission for complications was 1.5 days for MINILAP and 2.6 days for LAP. Cost of MINILAP was at least $1900 less than that of LAP because of shorter total hospital stay, shorter operation time, and lower equipment cost. Conclusions. Compared with L AP, MINILAP was more cost-effective and produced less morbidity. Patie nt satisfaction with the procedures was similar. MINILAP is an excelle nt alternative to IAP for prostate cancer staging in general urology p ractice. Copyright 1997 by Elsevier Science Inc.