Zorn Kevin C, Gofrit Ofer N, Steinberg Gary P, Taxy Jerome B, Zagaja Gregory P, Shalhav Arieh L
Section of Urology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois 60637, USA.
J Endourol. 2008 Jun;22(6):1303-9. doi: 10.1089/end.2008.0009.
The main objective of radical prostatectomy (RP) is optimal oncologic resection with preservation of sexual function (SF). During our initial experience with robot-assisted laparoscopic radical prostatectomy (RLRP), we noted a high rate of posterolateral location of positive surgical margins (PSM) with nerve preservation (NP). With its magnified view of the surgical field and improved instrument precision, one potential advantage of RLRP is the ability to tailor the degree of NP. We evaluated the effect of a protocol for side-specific NP based on preoperative variables on PSM rates and SF outcomes.
Between June and November 2006, 150 consecutive RLRPs were performed using a surgical protocol to select side-specific NP techniques (interfascial [IF], partial extrafascial [pEF], and wide extrafascial resection [WEFR]) based on preoperative risk factors (clinical stage, biopsy Gleason score, percentage of positive cores and maximal core cancer percentage, and preoperative PSA). Pathologic and SF outcomes in these patients were compared with those of a control group of 245 consecutive RLRPs in whom non-selective IF dissection was performed. All data were prospectively collected.
Mean patient age, PSA, clinical stage, biopsy Gleason score and positive core involvement, pathologic Gleason score, and stage were comparable among the two groups. The overall PSM rate (12.6% nu 20.4%; P = 0.04) and posterolateral location of PSMs (37% nu 70%; P = 0.04) were significantly lower in the study group. At 12 months, potency was reported in 80%, 67%, and 11% of men undergoing bilateral IFNP, partial extrafascial nerve preservation (pEFNP), and WEFR, respectively (P = 0.27).
Planning side-specific NP during RLRP, according to selected preoperative variables, can significantly reduce overall and posterolateral PSM rates. Furthermore, partial nerve sparing (pEFNP) also appears to confer favorable early SF outcomes.
根治性前列腺切除术（RP）的主要目标是在保留性功能（SF）的同时实现最佳肿瘤切除。在我们开展机器人辅助腹腔镜根治性前列腺切除术（RLRP）的初期经验中，我们注意到保留神经（NP）时手术切缘阳性（PSM）的后外侧定位发生率较高。凭借其对手术视野的放大视图和提高的器械精度，RLRP的一个潜在优势是能够调整NP的程度。我们评估了基于术前变量的侧方特异性NP方案对PSM发生率和SF结果的影响。
2006年6月至11月期间，连续进行了150例RLRP，采用一种手术方案根据术前危险因素（临床分期、活检Gleason评分、阳性核心的百分比和最大核心癌百分比以及术前PSA）选择侧方特异性NP技术（筋膜间[IF]、部分筋膜外[pEF]和广泛筋膜外切除[WEFR]）。将这些患者的病理和SF结果与245例连续进行非选择性IF解剖的RLRP对照组患者的结果进行比较。所有数据均前瞻性收集。
两组患者的平均年龄、PSA、临床分期、活检Gleason评分和阳性核心累及情况、病理Gleason评分和分期具有可比性。研究组的总体PSM发生率（12.6%对20.4%；P = 0.04）和PSM的后外侧定位（37%对70%；P = 0.04）显著更低。在12个月时，接受双侧IFNP、部分筋膜外神经保留（pEFNP）和WEFR的男性分别有80%、67%和11%报告有性功能（P = 0.27）。
在RLRP期间根据选定的术前变量规划侧方特异性NP可显著降低总体和后外侧PSM发生率。此外，部分神经保留（pEFNP）似乎也能带来良好的早期SF结果。
