Asimakopoulos Anastasios D, Miano Roberto, Di Lorenzo Nicola, Spera Enrico, Vespasiani Giuseppe, Mugnier Camille
UOC of Urology, Department of Surgery, University of Tor Vergata, Policlinico Casilino, Rome, Italy,
Surg Endosc. 2013 Nov;27(11):4297-304. doi: 10.1007/s00464-013-3046-9. Epub 2013 Jun 27.
This study aimed to compare the pentafecta rates between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RALP) and to identify prognostic factors predicting the pentafecta for each technique.
This prospective comparative study enrolled 248 consecutive male patients 70 years of age or younger with clinically localized prostate cancer [PCa: age ≤ 70 years, prostate-specific antigen (PSA) ≤ 10 ng/ml, biopsy Gleason score ≤ 7] who were fully continent, potent, and candidates for bilateral nerve-sparing (BNS) LRP or RALP. The pentafecta rates between LRP and RALP were compared. A logistic regression model was created to evaluate independent factors for achieving pentafecta.
In the final analysis, 91 LRP and 136 RALP patients were evaluated. The median follow-up period was 21 months for the 91 LRP patients and 18 months for the 136 RALP patients (p = 0.07). Of the 227 patients, 87 reached pentafecta [25 LRP patients (27.5 %) vs 62 RALP patients (45.6 %), p = 0.006]. Of the 140 patients who failed pentafecta, 90 (64.3 %) missed a single parameter. In these cases, erectile deficit was the leading cause of pentafecta failure, with a significant [corrected] difference between groups (80 % LRP cases that missed potency recovery [corrected] vs 53.3 % RALP, p = 0.007). Lower age, lower pathologic stage, and RALP are significantly associated with pentafecta as independent factors. For the pT3 disease, the two techniques did not differ significantly.
Patients submitted to BNS RP have low possibilities of achieving pentafecta. Use of the robotic platform by a single surgeon significantly enhances the possibility of achieving pentafecta independently of age and pathologic stage. Potency was the most difficult outcome to reach after surgery, and it was the main factor leading to pentafecta failure. LRP and RALP provide equivalent pentafecta rates for the pT3 disease and similar "tetrafecta" outcomes when potency recovery is not included among the postoperative expectations of the patient.
本研究旨在比较腹腔镜根治性前列腺切除术（LRP）和机器人辅助根治性前列腺切除术（RALP）的五联征发生率，并确定预测每种手术方式五联征的预后因素。
这项前瞻性比较研究纳入了248例年龄在70岁及以下、临床局限性前列腺癌（PCa：年龄≤70岁，前列腺特异性抗原[PSA]≤10 ng/ml，活检Gleason评分≤7）且完全控尿、性功能正常且适合双侧神经保留（BNS）LRP或RALP的男性患者。比较了LRP和RALP的五联征发生率。建立逻辑回归模型以评估实现五联征的独立因素。
最终分析中，评估了91例LRP患者和136例RALP患者。91例LRP患者的中位随访期为21个月，136例RALP患者的中位随访期为18个月（p = 0.07）。在227例患者中，87例达到五联征[25例LRP患者（27.5%）对62例RALP患者（45.6%），p = 0.006]。在140例未达到五联征的患者中，90例（64.3%）未达到单一参数。在这些病例中，勃起功能障碍是五联征失败的主要原因，两组之间存在显著[校正后]差异（80%的LRP病例未恢复性功能[校正后]对53.3%的RALP病例，p = 0.007）。年龄较低、病理分期较低和RALP作为独立因素与五联征显著相关。对于pT3期疾病，两种手术方式无显著差异。
接受BNS RP手术的患者实现五联征的可能性较低。由单一外科医生使用机器人平台显著提高了实现五联征的可能性，且与年龄和病理分期无关。性功能是术后最难达到的结果，也是导致五联征失败的主要因素。对于pT3期疾病，LRP和RALP的五联征发生率相当，当患者术后预期不包括性功能恢复时，两者的“四联征”结果相似。
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