Labanaris Apostolos P, Zugor Vahudin, Witt Jorn H
Department of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany. labanaris @ web.de
Urol Int. 2013;90(1):24-30. doi: 10.1159/000342969. Epub 2012 Dec 19.
The objective of this study is to evaluate the surgical, oncological and short-term functional outcomes in patients with a pathologic prostate specimen weight ≥100 g versus patients with a pathologic prostate specimen weight ≤50 g undergoing robot-assisted radical prostatectomy (RARP).
The records of 4,000 men who underwent RARP from February 2006 to April 2012 were reviewed retrospectively. A total of 185 men had a pathologic prostate specimen weight ≥100 g (group A). A matched pairs analysis was performed using our database to identify men with a pathologic prostate specimen weight ≤50 g but with equivalent clinicopathologic characteristics to serve as the control group (group B).
Our results indicated that although the intraoperative results were more than satisfying in patients with large glands, there is a significant increase in blood loss, operative time needed, increased need for bladder neck reconstruction as well as an increase in intraoperative complications. Nevertheless, patients with large glands exhibit less aggressive tumors, less positive surgical margins and a lower incidence of biochemical recurrence. Regarding functional outcomes, patients with larger glands had no difference regarding continence rates when compared to patients with smaller glands but exhibited significantly lower potency rates.
Although RARP in patients with a pathologic prostate specimen weight ≥100 g is technically challenging, in experienced hands it can be considered a safe procedure with excellent surgical, oncological and functional outcomes. Nevertheless, this conclusion is limited, in that it is from a single institution with a large case volume and may not be reflective of outcomes at centers with smaller volumes and less experience.
本研究的目的是评估病理前列腺标本重量≥100 g的患者与病理前列腺标本重量≤50 g的患者在接受机器人辅助根治性前列腺切除术（RARP）后的手术、肿瘤学及短期功能结果。
回顾性分析2006年2月至2012年4月期间4000例行RARP手术的男性患者的记录。共有185名男性患者的病理前列腺标本重量≥100 g（A组）。利用我们的数据库进行配对分析，以确定病理前列腺标本重量≤50 g但具有相同临床病理特征的男性患者作为对照组（B组）。
我们的结果表明，虽然大腺体患者的术中结果较为令人满意，但失血量显著增加，所需手术时间延长，膀胱颈重建需求增加以及术中并发症增多。然而，大腺体患者的肿瘤侵袭性较低，手术切缘阳性率较低，生化复发率也较低。关于功能结果，大腺体患者与小腺体患者相比，控尿率无差异，但勃起功能恢复率显著较低。
虽然病理前列腺标本重量≥100 g的患者行RARP手术在技术上具有挑战性，但在经验丰富的医生手中，可认为是一种安全的手术，具有良好的手术、肿瘤学及功能结果。然而，这一结论存在局限性，因为它来自一个病例数量众多的单一机构，可能无法反映病例数量较少且经验不足的中心的结果。
