Badani Ketan K, Kaul Sanjeev, Menon Mani
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.
Cancer. 2007 Nov 1;110(9):1951-8. doi: 10.1002/cncr.23027.
Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. Only a few large series have been published to date, with few long-term data available. The current study presents what to the authors' knowledge is the largest series of patients undergoing RAP with the longest follow-up to data available to date. Using a continuous quality improvement initiative, several technical refinements were adopted, evaluating the impact of this on patient outcome.
Over a 6-year period, 2766 consecutive men underwent RAP at the study institution. Data were collected prospectively including demographic, surgical, oncologic, and functional outcomes with up to 5-year follow-up. The first 200 and most recent 200 patients were compared to determine the impact of experience and quality improvement for patients.
The mean age of the patients was 60.2 years and the mean prostate-specific antigen (PSA) level at time of diagnosis was 6.43 ng/mL; 42.4% and 64.2% of patients, respectively, had a biopsy and pathologic Gleason sum of >/=7. The mean surgical and console time was 154 minutes and 116 minutes, respectively. Estimated blood loss was 100 mL; 96.7% of patients were discharged within 24 hours of surgery. At a median follow-up of 22 months, 7.3% of men had a PSA recurrence. The 5-year actuarial biochemical free survival rate was 84%.
To the authors' knowledge, the current study is the first report of 5-year outcomes in men undergoing RAP. These data demonstrate that RAP can be performed with favorable outcomes while minimizing complications. As experience increases, further improvements in clinicopathologic and functional parameters are achieved.
机器人辅助根治性前列腺切除术（RAP）是局限性前列腺癌患者主要的微创外科治疗方法。迄今为止，仅发表了少数大型系列研究，长期数据较少。本研究呈现了据作者所知最大规模的接受RAP治疗且随访时间最长的患者系列。通过持续质量改进计划，采用了多项技术改进措施，并评估其对患者结局的影响。
在6年期间，研究机构连续2766名男性接受了RAP治疗。前瞻性收集数据，包括人口统计学、手术、肿瘤学和功能结局，随访时间长达5年。比较前200例和最近200例患者，以确定经验和质量改进对患者的影响。
患者的平均年龄为60.2岁，诊断时前列腺特异性抗原（PSA）的平均水平为6.43 ng/mL；分别有42.4%和64.2%的患者活检和病理Gleason评分≥7。平均手术时间和控制台操作时间分别为154分钟和116分钟。估计失血量为100 mL；96.7%的患者在手术后24小时内出院。中位随访22个月时，7.3%的男性出现PSA复发。5年精算无生化复发生存率为84%。
据作者所知，本研究是关于接受RAP治疗男性5年结局的首次报告。这些数据表明，RAP可以取得良好疗效，同时将并发症降至最低。随着经验的增加，临床病理和功能参数得到进一步改善。
