Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer
Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer
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DOI：
10.1007/s00345-009-0379-z
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发表时间：
2009-10-01
影响因子：
3.4
通讯作者：
Roupret, Morgan
中科院分区：
文献类型：
--
作者：
Drouin, Sarah J.;Vaessen, Christophe;Roupret, Morgan
为了确定根治性前列腺切除术在接受开放式、腹腔镜或机器人手术治疗局限性前列腺癌患者中的癌症控制效果，我们收集了2000年至2004年期间接受治疗的所有患者的数据。记录239例患者的年龄、BMI、PSA、Gleason评分及2002年TNM分期、手术类型、围手术期参数、术后并发症、病理资料、复发情况及预后。总体而言，平均随访时间为49.7（18-103）个月。83例患者的手术是开放式的，85例是腹腔镜手术，71例是机器人辅助手术。机器人病例的输血率为5.6%，腹腔镜病例为5.9%，开放性膀胱切除术为9.6%（p = 0.03）。开放手术、腹腔镜手术和机器人手术的阳性切缘率分别为18.1%、18.8%和16.9%（p = 0.52）。在单因素分析中，只有切缘状态、PSA水平（> 10）和Gleason评分（> 7）与复发相关（p < 0.05），在多因素分析中，只有切缘状态和Gleason评分与复发相关。统计功效为0.7。总体而言，5年无PSA生存率为88%。特定手术入路的5年无PSA生存率在开放病例中为87.8%，在腹腔镜病例中为88.1%，在机器人辅助下切除术中为89.6%，并且在这些入路之间没有统计学差异（p = 0.93）。虽然开放式根治性膀胱切除术仍然是金标准手术，我们发现这三种技术在早期肿瘤学结果方面没有差异。然而，这些结果仍然是初步的，需要更大人群的进一步研究和更长的随访来对手术策略做出任何声明。
To determine the cancer control afforded by radical prostatectomy in patients who underwent either an open, laparoscopic, or robotic procedure for localized prostate cancer.We collected data on all patients treated between 2000 and 2004. We recorded age, BMI, PSA, Gleason score and 2002 TNM stage, type of surgery, perioperative parameters, postoperative complications, pathological data, recurrence and outcome.Data were analyzed for 239 patients. Overall, the mean follow-up was 49.7 (18-103) months. Surgical procedures were open in 83 patients, laparoscopic in 85, and robot-assisted in 71. The transfusion rate was 5.6% for robotic cases, 5.9% for laparoscopic cases and 9.6% for open prostatectomy (p = 0.03). The positive margin rates in open, laparoscopic, and robotic cases were 18.1, 18.8, and 16.9% (p = 0.52), respectively. Only margin status, PSA level (> 10), and Gleason score (> 7) were associated with recurrence in univariate analysis (p < 0.05), and only the margin status and the Gleason score were significant in multivariate analysis. The statistical power was 0.7. Overall, the 5-year PSA-free survival rate was 88%. The 5-year PSA-free survival rates for the specific surgical approaches were 87.8% in open cases, 88.1% in laparoscopic cases, and 89.6% in robot-assisted prostatectomies, and there was no statistical difference between the approaches (p = 0.93).Although open radical prostatectomy remains the gold standard procedure, we found no differences between these three techniques regarding early oncologic outcomes. These results are still preliminary, however, and further studies of larger populations with a longer follow-up are needed to make any statement regarding surgical strategy.