前列腺癌管理中根治性前列腺切除术手术和病理质量绩效优化指南：循证基础
Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base.
作者信息
Chin Joseph L, Srigley John, Mayhew Linda A, Rumble R Bryan, Crossley Claire, Hunter Amber, Fleshner Neil, Bora Bish, McLeod Robin, McNair Sheila, Langer Bernard, Evans Andrew
机构信息
Regional Head of Surgical Oncology, London Health Sciences Centre, London, ON;
出版信息
Can Urol Assoc J. 2010 Feb;4(1):13-25. doi: 10.5489/cuaj.08105.
BACKGROUND
The objective is to provide surgical and pathological guidelines for radical prostatectomy (RP) with or without concurrent pelvic lymph node dissection (PLND) to achieve optimal benefit for patients, with minimal risk of harm.
METHODS
For surgical questions, a literature search of MEDLINE, EMBASE and the Cochrane database was performed. A literature search for the pathological questions was not conducted since the protocol for invasive carcinomas of the prostate gland developed by the College of American Pathologists (CAP) was endorsed. Urologists and pathologists were consulted for their assessment of the surgical and pathological recommendations.
RESULTS
Limited high-quality evidence from 95 primary studies was available and, therefore, the expert panel developed recommendations on the basis of a consensus of the expert opinion of the working group and through a consultation with urologists and pathologists. In addition to the CAP protocol, some technical recommendations related to the handling and processing of the specimen were made.
CONCLUSION
Radical prostatectomy is recommended for the surgical treatment of prostate cancer, depending on a patient's preoperative risk profile. The panel unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%, rates of rectal injury of <1% and blood transfusion rates of <10% in non-anemic patients. Standard PLND should be mandatory in high-risk patients, should be recommended for intermediate-risk patients and should be optional for low-risk patients. The quality and effectiveness of this treatment and of subsequent patient care depend on good management, effective communication and reporting between surgeons and pathologists working together as part of a multidisciplinary team. The complete guideline document is posted on the Cancer Care Ontario website (www.cancercare.on.ca); search in their Toolbox, Quality Guidelines & Standards, Clinical Program category under "surgery."
背景
目的是提供行或不行同期盆腔淋巴结清扫术（PLND）的根治性前列腺切除术（RP）的手术和病理指南，以使患者获得最大益处，同时将伤害风险降至最低。
方法
对于手术问题，检索了MEDLINE、EMBASE和Cochrane数据库。由于美国病理学家学会（CAP）制定的前列腺浸润性癌方案已获认可，因此未对病理问题进行文献检索。就手术和病理建议的评估咨询了泌尿科医生和病理学家。
结果
有来自95项主要研究的有限高质量证据，因此，专家小组在工作组专家意见共识的基础上，并通过与泌尿科医生和病理学家协商制定了建议。除了CAP方案外，还提出了一些与标本处理和加工相关的技术建议。
结论
根据患者术前风险状况，建议行根治性前列腺切除术治疗前列腺癌。专家小组一致确定，RP的目标是pT2疾病的切缘阳性率<25%，死亡率<1%，直肠损伤率<1%，非贫血患者输血率<10%。标准PLND对高危患者应是强制性的，对中危患者应推荐，对低危患者应是可选择的。这种治疗及后续患者护理的质量和有效性取决于作为多学科团队一部分的外科医生和病理学家之间的良好管理以及有效的沟通和报告。完整的指南文件发布在安大略癌症护理网站（www.cancercare.on.ca）上；在其工具箱、质量指南与标准、临床项目类别下的“手术”中搜索。
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