Vita-Salute San Raffaele University, Milan, Italy.
Eur Urol. 2012 Sep;62(3):368-81. doi: 10.1016/j.eururo.2012.05.057. Epub 2012 Jun 7.
Radical retropubic prostatectomy (RRP) has long been the most common surgical technique used to treat clinically localized prostate cancer (PCa). More recently, robot-assisted radical prostatectomy (RARP) has been gaining increasing acceptance among patients and urologists, and it has become the dominant technique in the United States despite a paucity of prospective studies or randomized trials supporting its superiority over RRP.
A 2-d consensus conference of 17 world leaders in prostate cancer and radical prostatectomy was organized in Pasadena, California, and at the City of Hope Cancer Center, Duarte, California, under the auspices of the European Association of Urology Robotic Urology Section to systematically review the currently available data on RARP, to critically assess current surgical techniques, and to generate best practice recommendations to guide clinicians and related medical personnel. No commercial support was obtained for the conference.
A systematic review of the literature was performed in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.
The results of the systematic literature review were reviewed, discussed, and refined over the 2-d conference. Key recommendations were generated using a Delphi consensus approach. RARP is associated with less blood loss and transfusion rates compared with RRP, and there appear to be minimal differences between the two approaches in terms of overall postoperative complications. Positive surgical margin rates are at least equivalent with RARP, but firm conclusions about biochemical recurrence and other oncologic end points are difficult to draw because the follow-up in existing studies is relatively short and the overall experience with RARP in locally advanced PCa is still limited. RARP may offer advantages in postoperative recovery of urinary continence and erectile function, although there are methodological limitations in most studies to date and a need for well-controlled comparative outcomes studies of radical prostatectomy surgery following best practice guidelines. Surgeon experience and institutional volume of procedures strongly predict better outcomes in all relevant domains.
Available evidence suggests that RARP is a valuable therapeutic option for clinically localized PCa. Further research is needed to clarify the actual role of RARP in patients with locally advanced disease.
根治性前列腺切除术（RRP）长期以来一直是治疗局限性前列腺癌（PCa）最常用的手术方法。最近，机器人辅助根治性前列腺切除术（RARP）在患者和泌尿科医生中越来越受欢迎，尽管缺乏支持其优于 RRP 的前瞻性研究或随机试验，但它已成为美国的主要技术。
在欧洲泌尿外科学会机器人泌尿外科分会的主持下，在加利福尼亚州帕萨迪纳市和加利福尼亚州杜阿尔特市的希望之城癌症中心，组织了一次由 17 位前列腺癌和根治性前列腺切除术领域的世界领先专家参加的为期两天的共识会议，对 RARP 目前可用的数据进行系统回顾，对当前的手术技术进行批判性评估，并提出最佳实践建议，以指导临床医生和相关医疗人员。会议没有获得商业支持。
按照系统评价和荟萃分析报告的首选报告项目进行了文献系统回顾。
在为期两天的会议上，对文献系统回顾的结果进行了审查、讨论和完善。使用 Delphi 共识方法生成了关键建议。与 RRP 相比，RARP 出血量和输血率较低，两种方法在术后总体并发症方面似乎差异极小。RARP 的阳性切缘率至少与 RRP 相当，但由于现有研究的随访时间相对较短，以及 RARP 在局部晚期 PCa 中的总体经验仍然有限，因此很难得出关于生化复发和其他肿瘤学终点的明确结论。RARP 可能在术后恢复尿控和勃起功能方面具有优势，尽管迄今为止大多数研究都存在方法学限制，并且需要根据最佳实践指南对根治性前列腺切除术进行对照性结果研究。外科医生的经验和机构手术量强烈预测在所有相关领域的更好结果。
现有证据表明，RARP 是治疗局限性 PCa 的一种有价值的治疗选择。需要进一步的研究来阐明 RARP 在局部晚期疾病患者中的实际作用。
