耻骨后、会阴及腹腔镜下根治性前列腺切除术治疗局限性前列腺癌后切缘阳性的部位

Location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organ-confined prostate cancer.

作者信息

Salomon Laurent, Anastasiadis Aristotelis G, Levrel Olivier, Katz Ran, Saint Fabien, de la Taille Alexandre, Cicco Antony, Vordos Dimitri, Hoznek Andras, Chopin Dominique, Abbou Clement Claude

机构信息

Department of Urology, Henri Mondor Hospital, Creteil, France.

出版信息

Urology. 2003 Feb;61(2):386-90. doi: 10.1016/s0090-4295(02)02255-0.

DOI:10.1016/s0090-4295(02)02255-0

PMID:12597953

Abstract

OBJECTIVES

To evaluate and compare the location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organ-confined prostate cancer (pT2).

METHODS

From 1988 to 2001, 538 patients underwent radical prostatectomy for clinically localized prostate cancer. Patient age at surgery, clinical stage, preoperative prostate-specific antigen, and Gleason score of positive biopsies were noted. Postoperatively, specimen weight, final Gleason score, and capsular, seminal vesicle, and lymph node status, as well as tumor volume, were studied. The incidence and location of positive margins and the pathologic stage were noted according to the surgical approach.

RESULTS

A total of 371 patients (69.5%) had organ-confined tumors. Of the 371 patients, 116 underwent the retropubic, 86 the perineal, and 169 the laparoscopic approach, and positive surgical margins were noted in 22 (18.9%), 12 (13.9%), and 32 (18.9%) patients, respectively. Positive surgical margins were reported in 72 specimen locations, 32 (44.4%) at the apex, 17 (23.6%) at the bladder neck, and 29 (31.9%) posterolaterally. The distribution for the retropubic, perineal, and laparoscopic approaches was apex in 50%, 33.3%, and 44.4%, bladder neck in 29.1%, 41.7%, and 13.9%, and posterolaterally in 20.8%, 25%, and 41.6%, respectively.

CONCLUSIONS

In our series, each approach had a specific high-risk location of positive margins: the apex for the retropubic, the bladder neck for the perineal, and posterolaterally for the laparoscopic approach. Improvements in the surgical techniques should take these specific locations under consideration to decrease the incidence of positive surgical margins.

摘要

目的

评估并比较耻骨后、经会阴及腹腔镜根治性前列腺切除术治疗局限性前列腺癌（pT2）后阳性手术切缘的位置。

方法

1988年至2001年期间，538例患者接受了针对临床局限性前列腺癌的根治性前列腺切除术。记录患者手术时的年龄、临床分期、术前前列腺特异性抗原以及阳性活检标本的Gleason评分。术后，研究标本重量、最终Gleason评分、包膜、精囊及淋巴结状态以及肿瘤体积。根据手术方式记录阳性切缘的发生率及位置以及病理分期。

结果

共有371例患者（69.5%）患有局限性肿瘤。在这371例患者中，116例行耻骨后手术，86例行经会阴手术，169例行腹腔镜手术，阳性手术切缘分别见于22例（18.9%）、12例（13.9%）及32例（18.9%）患者。共报告72个标本位置存在阳性切缘，其中尖部32个（44.4%），膀胱颈部17个（23.6%），后外侧29个（31.9%）。耻骨后、经会阴及腹腔镜手术方式的分布情况分别为：尖部占50%、33.3%及44.4%，膀胱颈部占29.1%、41.7%及13.9%，后外侧占20.8%、25%及41.6%。