Guru Khurshid A, Perlmutter Adam E, Sheldon Matthew J, Butt Zubair M, Zhang Shaozeng, Tan Wei, Wilding Gregory, Kim Hyung L, Mohler James L
Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
J Endourol. 2009 Jan;23(1):123-7. doi: 10.1089/end.2008.0398.
The apex is the most common site of an involved surgical margin after robot-assisted radical prostatectomy. We assessed the impact of two surgical techniques for dorsal vein control on surgical margins rates.
From August 2005 to January 2008, 480 patients underwent robot-assisted radical prostatectomy at Roswell Park Cancer Institute. The Roswell Park Cancer Institute Quality Assurance robotic prostatectomy database was reviewed to identify all patients with prostate cancer at the apex on final pathologic evaluation. The rate of positive apical margins was compared between two surgical techniques. Group 1 consisted of 145 patients who underwent apical dissection after cold incision of the dorsal venous complex (DVC) without previous suture ligation, and group 2 consisted of 158 patients who underwent suture ligation of the DVC before apical dissection.
Of 480 patients, 303 (63%) patients had prostate cancer in the apex. Age, body mass index, prostate-specific antigen level, and clinical stage were similar in both groups. The overall apical positive margin rate was 5%. Group 1 patients had an apical positive margin rate of 2%, while group 2 patients had a positive margin rate of 8% (P = 0.02). Mean operative blood loss estimated by the attending anesthesiologist was 331 mL and 268 mL in group 1 and group 2, respectively (P = 0.044). One patient in group 1 needed blood transfusion.
Cold incision of the DVC before suture ligation reduces the rate of apical margin involvement during robot-assisted radical prostatectomy.
尖部是机器人辅助根治性前列腺切除术后手术切缘受累最常见的部位。我们评估了两种背静脉控制手术技术对手术切缘率的影响。
2005年8月至2008年1月，480例患者在罗斯韦尔帕克癌症研究所接受了机器人辅助根治性前列腺切除术。回顾罗斯韦尔帕克癌症研究所质量保证机器人前列腺切除术数据库，以确定所有在最终病理评估时前列腺尖部患有癌症的患者。比较两种手术技术的尖部切缘阳性率。第1组由145例患者组成，他们在未预先缝合结扎背静脉复合体（DVC）的情况下进行冷切口后行尖部解剖，第2组由158例患者组成，他们在尖部解剖前行DVC缝合结扎。
480例患者中，303例（63%）前列腺尖部患有癌症。两组患者的年龄、体重指数、前列腺特异性抗原水平和临床分期相似。总体尖部切缘阳性率为5%。第1组患者的尖部切缘阳性率为2%，而第2组患者的切缘阳性率为8%（P = 0.02）。主刀麻醉师估计的第1组和第2组平均术中失血量分别为331 mL和268 mL（P = 0.044）。第1组有1例患者需要输血。
在缝合结扎前对DVC进行冷切口可降低机器人辅助根治性前列腺切除术中尖部切缘受累的发生率。
