Department of Urology, City of Hope, Duarte, California, USA.
J Urol. 2010 Jan;183(1):133-7. doi: 10.1016/j.juro.2009.08.134.
We report on outcomes of robotic assisted laparoscopic radical prostatectomy as salvage local therapy for radiation resistant prostate cancer.
We retrospectively reviewed the charts of all patients who underwent robotic assisted laparoscopic radical prostatectomy for biopsy proven prostate cancer after primary radiation treatment. Patient characteristics, intraoperative and perioperative data, and oncological and functional outcomes were assessed.
A total of 18 patients were identified with a median followup of 18 months (range 4.5 to 40). Primary treatment was brachytherapy in 8 patients and external beam radiation in 8, while 2 underwent proton beam therapy. Median age at salvage robotic assisted laparoscopic radical prostatectomy was 67 years (range 53 to 76). Median preoperative prostate specific antigen was 6.8 ng/ml (range 1 to 28.9) and median time to surgery after primary treatment with radiation was 79 months (range 7 to 146). Median operative parameters for estimated blood loss, surgery length and hospital stay were 150 ml, 2.6 hours and 2 days, respectively. No patient required conversion to open surgery or a blood transfusion, or experienced a rectal injury. Perioperative complications occurred in 7 patients (39%) of which the most common was urine leak identified by postoperative cystogram. Five patients (28%) had a positive surgical margin. Although some patients had limited followup, 6 (33%) were continent and 67% were free of biochemical progression.
Robotic assisted laparoscopic radical prostatectomy can be performed safely as salvage local therapy after failed radiation therapy. Outcomes are comparable to those of large series of open salvage prostatectomy.
我们报告了机器人辅助腹腔镜根治性前列腺切除术作为放射抵抗性前列腺癌挽救性局部治疗的结果。
我们回顾性分析了所有因初次放射治疗后经活检证实前列腺癌而行机器人辅助腹腔镜根治性前列腺切除术的患者的病历。评估了患者特征、术中及围手术期数据以及肿瘤学和功能学结果。
共确定了 18 例患者，中位随访时间为 18 个月（4.5 至 40 个月）。8 例患者的初始治疗为近距离放射治疗，8 例患者为外照射放射治疗，2 例患者行质子束治疗。挽救性机器人辅助腹腔镜根治性前列腺切除术的中位年龄为 67 岁（53 至 76 岁）。中位术前前列腺特异抗原为 6.8ng/ml（1 至 28.9），初次放射治疗后行手术的中位时间为 79 个月（7 至 146 个月）。估计失血量、手术时间和住院时间的中位手术参数分别为 150ml、2.6 小时和 2 天。无患者需要转为开放性手术或输血，也未发生直肠损伤。7 例（39%）患者发生围手术期并发症，最常见的是术后通过膀胱造影术发现的尿漏。5 例（28%）患者有阳性切缘。尽管一些患者的随访时间有限，但有 6 例（33%）患者有控尿能力，67%的患者无生化进展。
机器人辅助腹腔镜根治性前列腺切除术可作为放射治疗失败后的挽救性局部治疗安全进行，其结果与大型开放性挽救性前列腺切除术系列结果相当。
