经耻骨后、会阴及腹腔镜途径的根治性前列腺切除术：一个中心的12年经验

Radical prostatectomy by the retropubic, perineal and laparoscopic approach: 12 years of experience in one center.

作者信息

Salomon Laurent, Levrel Olivier, de la Taille Alexandre, Anastasiadis Aristotelis G, Saint Fabien, Zaki Safawat, Vordos Dimitrios, Cicco Antony, Olsson L Eric, Hoznek Andras, Chopin Dominique, Abbou Clement-Claude

机构信息

Department of Urology, C.H.U. Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.

出版信息

Eur Urol. 2002 Aug;42(2):104-10; discussion 110-1. doi: 10.1016/s0302-2838(02)00263-4.

DOI:10.1016/s0302-2838(02)00263-4

PMID:12160579

Abstract

OBJECTIVES

We retrospectively evaluated the oncological outcome of radical prostatectomy performed by the retropubic, perineal and laparoscopic approaches.

METHODS

From 1988 to 2000, 401 patients underwent radical prostatectomy for localized prostate cancer by the retropubic, perineal or laparoscopic approach. Age, clinical stage, preoperative PSA and Gleason score of positive biopsies were noted. Operating time, complication rate, transfusion rate, length of hospital stay, catheterization time and pathological results were reviewed. Kaplan-Meier analysis was used to evaluate the likelihood of biochemical recurrence (PSA > or =0.2 ng/ml).

RESULTS

There were no significant differences between the three groups regarding preoperative characteristics, except for PSA (21.4 ng/ml, 13.2 ng/ml, and 11.6 ng/ml for the retropubic, perineal, and laparoscopic approach, p<0.05) and the frequency of stage T1c tumors (31.7%, 47.1% and 63.5%, respectively, p<0.05). The operating time was significantly longer in the laparoscopic approach (285 min) compared to the retropubic and perineal techniques (197 min and 178 min, respectively). The retropubic approach was associated with a higher transfusion rate (26.2% versus 15.9% and 2.9% with the perineal and laparoscopic approaches), longer bladder catheterization time (15.9 days versus 11.7 days and 6.8 days, respectively), and longer hospital stay (15.2 days versus 8.5 days and 7.4 days, respectively) (p<0.05 for each). With the retropubic, perineal and laparoscopic approaches, medical complication rates were 8.3%, 4.2% and 5.1%, and surgical complication rates were 16.5%, 12.7% and 13.1%, respectively. The rates of pathological stage pT2 tumors were 62.1%, 72.2% and 75.9%, in the retropubic, perineal and laparoscopic groups, respectively. Positive surgical margins in pT2 tumors were noted in 19%, 14% and 22%, respectively. The actuarial 3-year recurrence-free survival rates were not significantly different between the three techniques (75%, 85.2% and 84.1%, respectively; 91.7%, 95.8% and 90.4% among patients with organ-confined tumors).

CONCLUSION

Despite changes in patient selection criteria over time, and the relatively short follow-up, this study showed no significant difference in oncologic outcome between the retropubic, perineal and laparoscopic approaches to radical prostatectomy.

摘要

目的

我们回顾性评估了经耻骨后、会阴及腹腔镜途径行根治性前列腺切除术的肿瘤学结局。

方法

1988年至2000年期间，401例患者因局限性前列腺癌经耻骨后、会阴或腹腔镜途径接受了根治性前列腺切除术。记录了患者的年龄、临床分期、术前前列腺特异性抗原（PSA）水平以及阳性活检标本的Gleason评分。回顾了手术时间、并发症发生率、输血率、住院时间、导尿时间及病理结果。采用Kaplan-Meier分析评估生化复发（PSA≥0.2 ng/ml）的可能性。

结果

三组患者的术前特征除PSA（耻骨后途径为21.4 ng/ml，会阴途径为13.2 ng/ml，腹腔镜途径为11.6 ng/ml，p<0.05）及T1c期肿瘤的发生率（分别为31.7%、47.1%和63.5%，p<0.05）外，无显著差异。与耻骨后及会阴手术技术（分别为197分钟和178分钟）相比，腹腔镜途径的手术时间显著更长（285分钟）。耻骨后途径的输血率更高（26.2%，而会阴及腹腔镜途径分别为15.9%和2.9%），膀胱导尿时间更长（分别为15.9天、11.7天和6.8天），住院时间也更长（分别为15.2天、8.5天和7.4天）（每项比较p<0.05）。耻骨后、会阴及腹腔镜途径的医疗并发症发生率分别为8.3%、4.2%和5.1%，手术并发症发生率分别为16.5%、12.7%和13.1%。耻骨后、会阴及腹腔镜组的病理分期为pT2期肿瘤的发生率分别为62.1%、72.2%和75.9%。pT2期肿瘤的手术切缘阳性率分别为19%、14%和22%。三种手术技术的3年无复发生存率无显著差异（分别为75%、85.2%和84.1%；器官局限性肿瘤患者中分别为91.7%、95.8%和90.4%）。