Joniau S G, Van Baelen A A, Hsu C Y, Van Poppel H P
Department of Urology, University Hospitals KULeuven, Herestraat 49, 3000 Leuven, Belgium.
Adv Urol. 2012;2012:706309. doi: 10.1155/2012/706309. Epub 2012 Jan 12.
The role of surgery in clinical stage T3 prostate cancer (cT3 PCa) is still subject to debate. We reviewed the records of 139 consecutive patients who underwent a radical prostatectomy (RP) for cT3 PCa with a mean follow-up of 8 years. All data related to surgical and perioperative complications were collected. Continence and erectile function were assessed at 12 months postoperatively and long-term oncologic outcomes were analyzed. Rectal injury and injury of the obturator nerve occurred both in 0.7% of cases. No serious in-hospital complications were noted and no reintervention was needed. Lymphatic leakage was noted in 2.2% of patients and 1.4% experienced prolonged drainage of urine. In 7.2%, wound-related problems occurred. Anastomotic stricture occurred in 2.9%. These complication rates were not different compared to surgical series of RP in localized PCa. At 12 months, complete continence was 87.8% and erectile function had fully recovered in 6% and 10% of patients who underwent a non-nerve sparing or unilateral nerve-sparing procedure, respectively. 10-year estimated biochemical PFS, clinical PFS, CSS and OS were 51.8%, 85.6%, 94.6% and 85.9%, respectively. In cT3 PCa, RP is technically feasible with morbidity comparable to RP in clinically localized PCa. Long-term oncologic control was excellent.
手术在临床分期为T3期前列腺癌（cT3 PCa）中的作用仍存在争议。我们回顾了139例连续接受根治性前列腺切除术（RP）治疗cT3 PCa患者的记录，平均随访时间为8年。收集了所有与手术及围手术期并发症相关的数据。术后12个月评估控尿和勃起功能，并分析长期肿瘤学结局。直肠损伤和闭孔神经损伤的发生率均为0.7%。未发现严重的院内并发症，也无需再次干预。2.2%的患者出现淋巴漏，1.4%的患者出现尿液引流时间延长。7.2%的患者出现与伤口相关的问题。吻合口狭窄发生率为2.9%。这些并发症发生率与局限性PCa的RP手术系列相比无差异。术后12个月时，完全控尿率为87.8%，在接受非保留神经或单侧保留神经手术的患者中，分别有6%和10%的患者勃起功能完全恢复。10年估计生化无进展生存期（PFS）、临床PFS、癌症特异性生存率（CSS）和总生存期（OS）分别为51.8%、85.6%、94.6%和85.9%。在cT3 PCa中，RP在技术上是可行的，其发病率与临床局限性PCa的RP相当。长期肿瘤学控制效果良好。
