Trabulsi Edouard J, Linden Robert A, Gomella Leonard G, McGinnis Davis E, Strup Stephen E, Lallas Costas D
Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Can J Urol. 2008 Apr;15(2):3994-9.
The addition of robotic assistance with the da Vinci surgical system for performing laparoscopic radical prostatectomy has been reported to improve surgical outcomes. In order to evaluate the benefit of robotic assistance to improve cancer control in a center with an established laparoscopic radical prostatectomy program, we evaluated the incidence of positive surgical margins in both transperitoneal laparoscopic (LRP) and robotically assisted laparoscopic radical prostatectomy (RALP).
We performed an Institutional Review Board (IRB) approved, retrospective review of 247 men with clinically localized prostate cancer treated with either a LRP or a RALP from March 2000 to August 2006. Pathology reports were reviewed for both preoperative and postoperative Gleason score as well as clinical and pathological stage. Surgical pathology specimens were evaluated using a whole mount, step section technique. Extracapsular extension, seminal vesicle invasion and positive margins were noted when present in the final surgical pathologic specimens.
One hundred ninety seven patients underwent LRP, and 50 patients underwent RALP. Seven of the 197 LRP required open conversion to retropubic radical prostatectomy, and were excluded. None of the RALP were converted. The overall positive surgical margin rate for LRP and RALP was 18% (35/190) and 6% (3/50), respectively (p = 0.032). When examining pathologically organ confined specimens (pT2), the positive surgical margin rate was 12% (20/161) and 4.7% (2/43) for the LRP and RALP cohorts, respectively (p = 0.181). For pathologic disease that has spread outside the capsule (pT3/T4), the positive surgical margin rate was 54% (15/28) and 14% (1/7) for LRP and RALP, respectively (p = 0.062). Patient age, race and prostate volume were not significant factors in the incidence of positive surgical margins.
The addition of robotic assistance to an established laparoscopic radical prostatectomy program appears to reduce the incidence of positive surgical margins. Data is maturing to determine whether this will lead to improved functional and oncologic outcomes.
据报道，在进行腹腔镜根治性前列腺切除术时增加达芬奇手术系统的机器人辅助可改善手术效果。为了评估在一个已开展腹腔镜根治性前列腺切除术项目的中心，机器人辅助对改善癌症控制的益处，我们评估了经腹腹腔镜根治性前列腺切除术（LRP）和机器人辅助腹腔镜根治性前列腺切除术（RALP）中手术切缘阳性的发生率。
我们进行了一项经机构审查委员会（IRB）批准的回顾性研究，对2000年3月至2006年8月期间接受LRP或RALP治疗的247例临床局限性前列腺癌男性患者进行了研究。审查病理报告以获取术前和术后的Gleason评分以及临床和病理分期。使用整装切片技术对手术病理标本进行评估。在最终手术病理标本中发现有包膜外扩展、精囊侵犯和切缘阳性时进行记录。
197例患者接受了LRP，50例患者接受了RALP。197例LRP中有7例需要转为开放性耻骨后根治性前列腺切除术，被排除在外。RALP均未转为开放手术。LRP和RALP的总体手术切缘阳性率分别为18%（35/190）和6%（3/50）（p = 0.032）。在检查病理上局限于器官的标本（pT2）时，LRP和RALP队列的手术切缘阳性率分别为12%（20/161）和4.7%（2/43）（p = 0.181）。对于已扩散至包膜外的病理疾病（pT3/T4），LRP和RALP的手术切缘阳性率分别为54%（15/28）和14%（1/7）（p = 0.062）。患者年龄、种族和前列腺体积不是手术切缘阳性发生率的显著因素。
在已有的腹腔镜根治性前列腺切除术项目中增加机器人辅助似乎可降低手术切缘阳性的发生率。数据正在不断完善，以确定这是否会带来更好的功能和肿瘤学结果。
