Zorn Kevin C, Gofrit Ofer N, Orvieto Marcelo A, Mikhail Albert A, Zagaja Gregory P, Shalhav Arieh L
Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois 60637, United States.
Eur Urol. 2007 Mar;51(3):755-62; discussion 763. doi: 10.1016/j.eururo.2006.10.019. Epub 2006 Oct 27.
Robotic-assisted laparoscopic radical prostatectomy (RLRP) is increasingly becoming an alternative to open and laparoscopic radical prostatectomy in the treatment of localized prostate cancer. RLRP has been associated with low morbidity, short convalescence and comparable oncologic and functional outcomes. We report our initial experience of 300 consecutive cases with selective use of interfascial nerve preservation (IFNP).
Between February 2003 and September 2005, 300 consecutive men underwent RLRP at our institution. Patients were followed prospectively with validated questionnaires.
Mean operative time was 282 minutes with an estimated blood loss of 273 ml. The intra-operative complication rate was 2.3% with no mortality. Return to baseline (RTB) urinary function and subjective continence at 12 months were 71% and 90.2%, respectively. RTB sexual function and subjective potency at 12 months were 53% and 80.4%, respectively. Overall, the positive surgical margin (PSM) rate was 20.9%: 15.1% for pT2 and 52.1% for pT3 disease and 93.1% had an undetectable PSA (<0.1 ng/mL) with a mean follow-up of 17.3 months. Fifty-four percent of PSMs occured in a poster-lateral (PL) location. Retrospectively, IFNP was performed in 86.5% and 62.5% of pT2 and pT3 PSMs, respectively. Pathologic-T3 PSMs were found to occur significantly more often in a PL location when ipsilateral IFNP was performed when compared to non-IFNP (73% vs 33%, p=0.05).
IFNP appears to result in favorable return of potency, however, postero-lateral PSMs appear to occur more frequently with this technique. Proper patient selection for robotic surgery and nerve-preservation appears to be critical in order to reduce PSM and optimize the oncologic efficacy of this technology.
机器人辅助腹腔镜根治性前列腺切除术（RLRP）在局限性前列腺癌的治疗中越来越多地成为开放性和腹腔镜根治性前列腺切除术的替代方法。RLRP具有发病率低、康复期短以及肿瘤学和功能预后相当的特点。我们报告了连续300例选择性使用筋膜间神经保留（IFNP）的初步经验。
2003年2月至2005年9月期间，我院连续300名男性接受了RLRP。采用经过验证的问卷对患者进行前瞻性随访。
平均手术时间为282分钟，估计失血量为273毫升。术中并发症发生率为2.3%，无死亡病例。12个月时尿功能恢复至基线水平（RTB）和主观控尿率分别为71%和90.2%。12个月时性功能恢复至基线水平（RTB）和主观勃起功能恢复率分别为53%和80.4%。总体而言，手术切缘阳性（PSM）率为20.9%：pT2期为15.1%，pT3期为52.1%，平均随访17.3个月时，93.1%的患者前列腺特异抗原（PSA）检测不到（<0.1 ng/mL）。54%的PSM发生在后外侧（PL）部位。回顾性分析显示，pT2和pT3期PSM分别有86.5%和62.5%进行了IFNP。与未进行同侧IFNP相比，进行同侧IFNP时，病理T3期PSM在后外侧部位的发生率明显更高（73%对33%，p=0.05）。
IFNP似乎能使勃起功能良好恢复，然而，采用该技术时后外侧PSM的发生率似乎更高。为了降低PSM并优化该技术的肿瘤学疗效，对机器人手术和神经保留进行恰当的患者选择似乎至关重要。
