评估前列腺癌患者行盆腔淋巴结清扫术后的淋巴结检出量：机器人辅助根治性前列腺切除术与开放根治性前列腺切除术在现代的比较。
Assessment of lymph node yield after pelvic lymph node dissection in men with prostate cancer: a comparison between robot-assisted radical prostatectomy and open radical prostatectomy in the modern era.
机构信息
Department of Urology, Columbia University Medical Center, New York, New York 10032, USA.
出版信息
J Endourol. 2010 Jul;24(7):1055-60. doi: 10.1089/end.2010.0128.
BACKGROUND AND PURPOSE
Studies of radical prostatectomy (RP) suggest that higher lymph node yield (LNY) improves tumor staging. Robot-assisted radical prostatectomy (RARP) is becoming increasingly popular, yet LNY data are not well reported. We compare LNY from contemporary open RP (ORP) with RARP at an academic center.
PATIENTS AND METHODS
A retrospective study was conducted of an Urologic Oncology Database. Between January 2005 and November 2009, 217 men underwent ORP with pelvic lymph node dissection (PLND); 99 underwent RARP with PLND by a single surgeon during the same period. Men were stratified according to the D'Amico risk criteria. For intermediate and high-risk disease, an extended PLND was performed. Patient demographic, operative, and pathologic variables were measured, and LNY was compared across groups.
RESULTS
No significant differences were seen between groups for race, body mass index, preoperative prostate-specific antigen level or biopsy Gleason score. Patients were younger for RARP vs ORP (P = 0.003) and had higher clinical tumor stage (P = 0.02). Operative time was longer (P = 0.03) and estimated blood loss was greater (P < 0.001) in the ORP group. Overall, only a borderline significant difference was seen in LNY between ORP and RARP (7.49 vs 6.35 nodes, respectively, P = 0.06). No difference was seen for intermediate and high-risk patients, with 7.7 vs 6.8 nodes for ORP and RARP, respectively (P = 0.27). The lymph node metastasis rate was 6.3%, with more positive nodes detected during ORP vs RARP: 19/217 (8.8%) vs 1/99 (1.0%), P = 0.009.
CONCLUSIONS
No significant differences were seen in LNY during RARP and ORP for intermediate and high-risk men. For experienced surgeons, RARP can achieve equivalent LNY as ORP. A future study with a larger sample size is necessary to make a definitive statement of equivalence.
背景与目的
研究表明根治性前列腺切除术（RP）中淋巴结检出数（LNY）越高，肿瘤分期越准确。机器人辅助根治性前列腺切除术（RARP）越来越普及，但目前关于 LNY 的数据报道并不充分。本研究比较了在学术中心行开放 RP（ORP）与 RARP 的 LNY。
患者与方法
对泌尿科肿瘤数据库进行回顾性研究。2005 年 1 月至 2009 年 11 月期间，217 例行 ORP 联合盆腔淋巴结清扫术（PLND）的患者，99 例行 RARP 联合 PLND 的患者。根据 D'Amico 风险标准对患者进行分层。对中高危患者行扩大的 PLND。比较各组间患者的人口统计学、手术和病理变量，并比较 LNY。
结果
两组间患者的种族、体质指数、术前前列腺特异性抗原水平或前列腺活检 Gleason 评分无显著差异。RARP 组患者年龄较 ORP 组小（P = 0.003），临床肿瘤分期更高（P = 0.02）。ORP 组手术时间更长（P = 0.03），术中失血量更多（P < 0.001）。尽管两组间 LNY 有轻微差异（ORP 组和 RARP 组分别为 7.49 个和 6.35 个，P = 0.06），但差异无统计学意义。中高危患者也无显著差异，ORP 组和 RARP 组分别为 7.7 个和 6.8 个（P = 0.27）。淋巴结转移率为 6.3%，ORP 组检出的阳性淋巴结数多于 RARP 组：217 例中有 19 例（8.8%），99 例中有 1 例（1.0%），P = 0.009。
结论
对于中高危患者，RARP 与 ORP 的 LNY 无显著差异。对于经验丰富的外科医生来说，RARP 可以达到与 ORP 相当的 LNY。需要更大样本量的未来研究来明确两者的等效性。
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