Antegrade radical retropubic prostatectomy with preliminary ligation of vascular pedicles in 614 consecutive patients.
Antegrade radical retropubic prostatectomy with preliminary ligation of vascular pedicles in 614 consecutive patients.
复制标题
对 614 名连续患者进行顺行根治性耻骨后前列腺切除术并初步结扎血管蒂。
DOI：
10.1093/jjco/hym051
复制
发表时间：
2007
影响因子：
2.4
通讯作者：
Y. Ishikawa
中科院分区：
文献类型：
--
作者：
S. Kawakami;I. Fukui;J. Yonese;Y. Okubo;Shinya Yamamoto;T. Tsukamoto;Y. Ishikawa
背景
我们介绍了我们的程序，顺行根治性耻骨后直肠癌切除术与初步结扎血管蒂和评估的时间趋势的患者特征，手术和肿瘤的结果在一个单一的机构超过12年的时间。
方法
从1994年4月至2005年12月，连续614例日本cT 1 - 3 N 0 M0前列腺癌患者在肿瘤操作前接受了血管蒂（背静脉复合体和前列腺蒂）初步结扎的顺行根治性前列腺切除术。生化进展定义为前列腺特异性抗原值超过0.2 ng/ml或手术后开始治疗。通过Kaplan-Meier方法计算生化无进展、癌症特异性和总生存曲线。
结果
在研究期间，术前PSA、临床T分期、手术持续时间、估计失血量均有所下降。病理分期明显下移，切缘阳性率也有所下降。在平均48个月的随访中，21名男性死亡，其中8人死于前列腺癌。总体和癌症特异性生存率分别为5年97/99%和10年89/95%。无论临床分期如何，新辅助激素治疗对患者的肿瘤结局均无有益影响。在370例单独手术治疗的患者中，临床T1/2疾病患者的5年癌症特异性和生化无进展生存率分别为99.6/80.5%和97.9/73.3%，T3疾病患者的5年癌症特异性和生化无进展生存率分别为95.5/41.9%和87.5/41.9%。在370例患者中，生化无进展生存期在12年期间显著改善（P < 0.0001）。
结论
顺行根治性直肠癌切除术结合血管蒂的初步结扎可以获得良好的肿瘤学结果。
BACKGROUND
We present our procedure of antegrade radical retropubic prostatectomy with preliminary ligation of vascular pedicles and assess the time trends of patient characteristics, surgical and oncological outcome in 614 consecutive patients in a single institution over a 12-year period.
METHODS
From April 1994 to December 2005, 614 consecutive Japanese patients with cT1-3N0M0 prostate cancer underwent antegrade radical prostatectomy with preliminary ligation of vascular pedicles (dorsal vein complex and prostatic pedicles) prior to the tumor manipulation. Biochemical progression is defined as prostate-specific antigen value over 0.2 ng/ml or the initiation of therapy after surgery. Biochemical progression-free, cancer-specific and overall survival curves were calculated by the Kaplan-Meier method.
RESULTS
During the study period pre-operative PSA, clinical T stage, duration of surgery, amount of estimated blood loss have decreased. Pathological stage showed a significant downward migration and the rate of positive surgical margin has also decreased. At a mean follow-up of 48 months, 21 men were dead including eight who died of prostate cancer. Overall and cancer-specific survival rates were 97/99% at 5 years and 89/95% at 10 years, respectively. Neoadjuvant hormonal treatment had no beneficial impact on oncological outcome of patients regardless of clinical stage. In 370 patients treated surgically alone, cancer-specific and biochemical progression-free survival rates were 99.6/80.5% at 5 years and 97.9/73.3% at 10 years for patients with clinical T1/2 disease and 95.5/41.9% at 5 years and 87.5/41.9% at 10 years for those with T3 disease, respectively. In the 370 patients biochemical progression-free survival has been significantly improved over the 12-year period (P < 0.0001).
CONCLUSIONS
Antegrade radical prostatectomy with preliminary ligation of vascular pedicles can be performed with excellent oncological outcome.