Xylinas E, Ploussard G, Paul A, Gillion N, Vordos D, Hoznek A, De La Taille A, Abbou C-C, Salomon L
Service d'urologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Prog Urol. 2010 Feb;20(2):116-20. doi: 10.1016/j.purol.2009.08.037. Epub 2009 Sep 25.
Prostate cancer incidence increases with age. Radical prostatectomy (RP) seems to be feasible for elderly well-selected patients. We report our experience with patients older than 75 years old who underwent laparoscopic RP.
From 2000 to 2007, 22 patients older than 75 years old at time of surgery were included in the study. The patient clinical characteristics, the peri- and postoperative data, and the pathological data were collected retrospectively. The overall, specific and PSA-free survival were analysed with Kaplan-Meier method. The functional results such as continence and erectile function were assessed by self-questionnaires.
The mean patient age was 75 years (75-81), the median PSA level was 10.77 ng/ml (5-30). The mean American Society of Anesthesiologists score was 2.1 (2-3). Two (9%) perioperative complications occurred but no conversion was necessary. Five patients (23%) had a pT3 disease and the overall positive surgical margins rate was 14%. With a median follow-up of 42 months, no patient has died and five had a biochemical recurrence. At 12-month follow-up, 82% of patients were continent (no pad) and potency (erection sufficient for intercourse) rate was 36% with or without the use of phosphodiesterase-5 inhibitors.
Laparoscopic RP is feasible for localized prostate cancer in elderly well-selected patients with satisfactory oncological and functional outcomes although the incontinence rate is increased comparing to younger patients.
前列腺癌发病率随年龄增长而增加。对于精心挑选的老年患者，根治性前列腺切除术（RP）似乎是可行的。我们报告了我们对75岁以上接受腹腔镜RP患者的经验。
从2000年到2007年，22例手术时年龄超过75岁的患者被纳入研究。回顾性收集患者的临床特征、围手术期和术后数据以及病理数据。采用Kaplan-Meier方法分析总生存率、特异性生存率和无PSA生存率。通过自我问卷评估诸如控尿和勃起功能等功能结果。
患者平均年龄为75岁（75 - 81岁），PSA中位数水平为10.77 ng/ml（5 - 30）。美国麻醉医师协会平均评分为2.1（2 - 3）。发生了2例（9%）围手术期并发症，但无需转为开放手术。5例患者（23%）患有pT3疾病，手术切缘阳性率总体为14%。中位随访42个月，无患者死亡，5例发生生化复发。在12个月随访时，82%的患者控尿良好（无需使用尿垫），无论是否使用磷酸二酯酶-5抑制剂，勃起功能（勃起足以进行性交）率为36%。
对于精心挑选的老年局限性前列腺癌患者，腹腔镜RP是可行的，肿瘤学和功能结果令人满意，尽管与年轻患者相比，尿失禁率有所增加。
