Touijer Karim, Eastham James A, Secin Fernando P, Romero Otero Javier, Serio Angel, Stasi Jason, Sanchez-Salas Rafael, Vickers Andrew, Reuter Victor E, Scardino Peter T, Guillonneau Bertrand
Department of Surgery, Service of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Urol. 2008 May;179(5):1811-7; discussion 1817. doi: 10.1016/j.juro.2008.01.026. Epub 2008 Mar 18.
In a nonrandomized prospective fashion we compared the oncological, functional and morbidity outcomes after laparoscopic and retropubic radical prostatectomy.
Between January 2003 and December 2005 a total of 1,430 consecutive men with clinically localized prostate cancer underwent radical prostatectomy, laparoscopic in 612 and retropubic in 818. The surgical approach was selected by the patient. Preoperative staging, respective surgical techniques, pathological examination and followup were uniform. Functional outcome was measured by patient completed health related quality of life questionnaire.
Positive surgical margin rates (11%) and freedom from progression (median followup 18 months) were comparable between laparoscopic and retropubic radical prostatectomy (HR 0.99 for laparoscopic vs retropubic radical prostatectomy, p = 0.9). We found no significant association between operation type and time to postoperative potency (HR 1.04 for laparoscopic vs retropubic radical prostatectomy; 95% CI 0.74, 1.46; p = 0.8). Patients who underwent laparoscopic radical prostatectomy were less likely to become continent than those treated with retropubic radical prostatectomy (HR 0.56 for laparoscopic vs retropubic radical prostatectomy; 95% CI 0.44, 0.70; p <0.0005). Laparoscopic radical prostatectomy was associated with less blood loss (mean ml +/- SD 315 +/- 186 vs 1,267 +/- 660) and lower overall transfusion rate (3% vs 49%). No significant difference was noted in cardiovascular, thromboembolic and urinary complications. Emergency room visits and readmissions were higher after laparoscopic radical prostatectomy (15% vs 11% and 4.6% vs 1.2%, respectively).
At our institution and during the study period laparoscopic radical prostatectomy and retropubic radical prostatectomy provided comparable oncological efficacy. Laparoscopic radical prostatectomy was associated with less blood loss and a lower transfusion rate, and higher postoperative hospital visits and readmission rate. While the recovery of potency was equivalent, that of continence was superior after retropubic radical prostatectomy.
我们采用非随机前瞻性方式，比较了腹腔镜根治性前列腺切除术和耻骨后根治性前列腺切除术后的肿瘤学、功能及发病情况。
2003年1月至2005年12月期间，共有1430例临床局限性前列腺癌患者连续接受了根治性前列腺切除术，其中612例行腹腔镜手术，818例行耻骨后手术。手术方式由患者选择。术前分期、各自的手术技术、病理检查及随访均保持一致。功能结局通过患者填写的与健康相关的生活质量问卷进行评估。
腹腔镜根治性前列腺切除术和耻骨后根治性前列腺切除术的手术切缘阳性率（11%）和无进展生存率（中位随访18个月）相当（腹腔镜与耻骨后根治性前列腺切除术相比，风险比为0.99，p = 0.9）。我们发现手术类型与术后性功能恢复时间之间无显著关联（腹腔镜与耻骨后根治性前列腺切除术相比，风险比为1.04；95%置信区间为0.74, 1.46；p = 0.8）。与接受耻骨后根治性前列腺切除术的患者相比，接受腹腔镜根治性前列腺切除术的患者控尿的可能性更小（腹腔镜与耻骨后根治性前列腺切除术相比，风险比为0.56；95%置信区间为0.44, 0.70；p <0.0005）。腹腔镜根治性前列腺切除术的失血量较少（平均毫升数±标准差为315±186 vs 1267±660），总体输血率较低（3% vs 49%）。在心血管、血栓栓塞和泌尿系统并发症方面未观察到显著差异。腹腔镜根治性前列腺切除术后的急诊就诊和再入院率较高（分别为15% vs 11%和4.6% vs 1.2%）。
在我们机构及研究期间，腹腔镜根治性前列腺切除术和耻骨后根治性前列腺切除术的肿瘤学疗效相当。腹腔镜根治性前列腺切除术的失血量较少，输血率较低，但术后医院就诊和再入院率较高。虽然性功能恢复相当，但耻骨后根治性前列腺切除术后的控尿恢复情况更佳。
