Martínez-Salamanca J I, Allona Almagro A
Department of Urology, Weill Medical College at Cornell University, New York, USA.
Actas Urol Esp. 2007 Apr;31(4):316-27. doi: 10.1016/s0210-4806(07)73644-6.
It is well known that radical prostatectomy (RP) is an excellent option in localized prostatic cancer especially from oncological control point of view. The efforts, during last decades, of the urological community in this field have been addressed in trying to improve functional outcomes (urinary and sexual morbidity) after the procedure. From the beginning of this century, three managements (open, robotic and laparoscopic) have been coexisting trying to get and prove the best results. The objective of this review has been to make the most exhaustive, rigorous and objective updating with the functional and oncological outcomes from the three (RP) techniques.
We have centered the comparison in four sections: perioperative, oncological outcomes, functional results and economic costs. With this purpose a systematic search was made in the following registers: PubMed, OVID, EMBASE and Cochrane Library, with the following terms: Retropubic RP. open RP, laparoscopic RP, robotic RP, Sexual function, urinary incontinence, quality of life, economic costs. At author's criteria, a total of 73 references were selected, that were individually analyzed.
Whatever the technique is, the mortality related to the procedure is extremely low, with little postoperative pain and minimum analgesic requirements. The oncological results are similar, measured in surgical margin terms: Open RP (14-20%), Laparoscopic RP (7.4-21.9%) and robotic RP (5.7-17.3%). Concerning functional results (sexual function and urinary continence), it is difficult to establish comparisons due to the multitude of existing byas (non randomized studies, different methods and measurement scales, different definitions, etc.) In the uni-insitutional studies, results seem to be equivalent.
Laparoscopic and robotic RP series are still pending of mature outcomes, related to long term biochemical control and functional results. It seems that with these managements, blood loss and transfusion needs are minor compared to open surgery. Robotic technology adds very interesting advantages that could have an important role in homogenize the minimally invasive management, but are still pending of validation at medium and long term.
众所周知，根治性前列腺切除术（RP）对于局限性前列腺癌而言是一个极佳的选择，尤其是从肿瘤学控制的角度来看。在过去几十年里，泌尿外科界在该领域的努力一直致力于改善该手术后的功能结局（泌尿和性功能障碍）。从本世纪初开始，三种手术方式（开放手术、机器人手术和腹腔镜手术）并存，试图获得并证明最佳效果。本综述的目的是对这三种（RP）技术的功能和肿瘤学结局进行最详尽、严谨和客观的更新。
我们将比较集中在四个方面：围手术期、肿瘤学结局、功能结果和经济成本。为此，我们在以下数据库进行了系统检索：PubMed、OVID、EMBASE和Cochrane图书馆，检索词如下：耻骨后RP、开放RP、腹腔镜RP、机器人RP、性功能、尿失禁、生活质量、经济成本。根据作者的标准，共筛选出73篇参考文献，并对其进行了逐一分析。
无论采用何种技术，与手术相关的死亡率都极低，术后疼痛轻微，镇痛需求 minimal。从手术切缘来看，肿瘤学结果相似：开放RP（14 - 20%）、腹腔镜RP（7.4 - 21.9%）和机器人RP（5.7 - 17.3%）。关于功能结果（性功能和尿失禁），由于存在众多偏差（非随机研究、不同的方法和测量量表、不同的定义等），难以进行比较。在单中心研究中，结果似乎相当。
腹腔镜和机器人RP系列在长期生化控制和功能结果方面的成熟结局仍有待观察。似乎采用这些手术方式时，与开放手术相比，失血和输血需求较少。机器人技术具有非常有趣的优势，可能在微创治疗的同质化方面发挥重要作用，但在中长期仍有待验证。
