Division of Urology, Department of Surgery, Taichung Veterans General Hospital, National Yang-Ming University, Taiwan.
Eur J Surg Oncol. 2013 Jan;39(1):107-13. doi: 10.1016/j.ejso.2012.10.003. Epub 2012 Oct 22.
To analyze the trifecta outcome (continence, potency, and cancer control) in 300 cases of robotic-assisted laparoscopic radical prostatectomy (RARP).
A prospective assessment of outcomes in 300 consecutive patients that underwent a RARP performed by a single surgeon. Patients were grouped according to D'Amico risk criteria: Group I consisted of 'low-risk' cases (n = 64), Group II consisted of 'intermediate-risk' cases (n = 88), and Group III consisted of 'high-risk' cases (n = 148). Patients were evaluated for perioperative complications and the trifecta outcome.
The operation time, blood loss, post-operative stay, duration of urethral catheterization, and perioperative complication rate were similar among all groups. The incidence of bilateral neurovascular bundle (NVB) preservation was significantly decreased with the increasing risk of cases (P < 0.001). The continence rates at the 1-week, 1-month, 3-month, 6-month, and 12-month follow-ups did not differ significantly between groups. The potency rates at the 12-month follow-up were not significantly different. The positive surgical margin and positive lymph node metastasis rate increased with the increasing risk of cases (P < 0.001). The biochemical recurrence rate (BCR, PSA >0.2 ng/mL) was 3.1, 11.36, and 19.59% in Groups I, II and III, respectively (P = 0.004). The trifecta outcome for RARP with bilateral NVB preservation showed no significant differences among groups.
Undergoing a RARP is safe and feasible in high-risk prostate cancer patients. Compared to low-risk and intermediate-risk groups, the high-risk group had a significant higher incidence of positive surgical margin, positive lymph node metastasis, and BCR rate.
分析 300 例机器人辅助腹腔镜根治性前列腺切除术（RARP）的三联（控尿、勃起功能和肿瘤控制）结果。
对 300 例连续接受单一外科医生行 RARP 的患者进行前瞻性结局评估。根据 D'Amico 风险标准对患者进行分组：I 组为“低危”病例（n = 64），II 组为“中危”病例（n = 88），III 组为“高危”病例（n = 148）。评估围手术期并发症和三联结局。
所有组的手术时间、失血量、术后住院时间、导尿管留置时间和围手术期并发症发生率相似。双侧神经血管束（NVB）保留的发生率随病例风险的增加而显著降低（P < 0.001）。1 周、1 个月、3 个月、6 个月和 12 个月随访时的控尿率在各组之间无显著差异。12 个月随访时的勃起功能率无显著差异。阳性切缘和阳性淋巴结转移率随病例风险的增加而增加（P < 0.001）。生化复发率（PSA>0.2ng/ml，BCR）分别为 I 组 3.1%、II 组 11.36%和 III 组 19.59%（P = 0.004）。双侧 NVB 保留的 RARP 三联结局在各组之间无显著差异。
在高危前列腺癌患者中，行 RARP 是安全可行的。与低危和中危组相比，高危组的阳性切缘、阳性淋巴结转移和 BCR 发生率显著更高。
