Masterson Timothy A, Wedmid Alexei, Sandhu Jaspreet S, Eastham James A
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
BJU Int. 2009 Aug;104(4):482-5. doi: 10.1111/j.1464-410X.2009.08428.x. Epub 2009 Feb 23.
To report the perioperative and functional outcomes of nine patients treated at our institution who had radical prostatectomy (RP) after previous pelvic radiotherapy (RT) for non-prostate malignancies.
From 1993 to 2007, nine patients had RP after external beam RT for testicular seminoma (six), anorectal cancer (two) and colon cancer (one). Clinical information was obtained from a prospective prostate cancer database.
RP was completed with no identifiable injury to adjacent structures in all nine patients. Four patients had significant pelvic fibrosis, and three required bilateral neurovascular bundle (NVB) resection. The NVB was preserved in the remaining six patients, four with good preoperative erectile function. However, no patient recovered erectile function after RP at a median (range) follow-up of 75 (12-172) months. Of seven men continent before RP, four required one or fewer pads daily and three were completely dry, achieving complete urinary control at a median (range) time of 7.5 (2-20) months. Two patients developed an anastomotic stricture, one being associated with concomitant ureteric stricture.
RP after pelvic RT for non-prostate malignancies was not associated with increased intraoperative morbidity. However, rates of anastomotic stricture, erectile dysfunction and urinary incontinence appeared to be higher than those reported after RP in men with no previous RT, and comparable with those seen in the salvage RP setting.
报告我院9例曾因非前列腺恶性肿瘤接受盆腔放疗（RT）后行根治性前列腺切除术（RP）患者的围手术期情况及功能转归。
1993年至2007年，9例患者因睾丸精原细胞瘤（6例）、肛管直肠癌（2例）和结肠癌（1例）在接受外照射放疗后行RP。临床信息来自前瞻性前列腺癌数据库。
所有9例患者均顺利完成RP，未发现对邻近结构有明显损伤。4例患者有明显盆腔纤维化，3例需要双侧神经血管束（NVB）切除。其余6例患者保留了NVB，其中4例术前勃起功能良好。然而，在中位（范围）75（12 - 172）个月的随访中，RP后无患者恢复勃起功能。RP前7例控尿的男性中，4例每天需要1片或更少尿垫，3例完全干爽，在中位（范围）7.5（2 - 20）个月时实现完全尿控。2例患者出现吻合口狭窄，1例合并输尿管狭窄。
非前列腺恶性肿瘤盆腔放疗后行RP与术中并发症增加无关。然而，吻合口狭窄、勃起功能障碍和尿失禁的发生率似乎高于既往未接受放疗的男性RP后报告的发生率，与挽救性RP中的情况相当。
