Koutlidis Nicolas, Duperron Céline, de la Vega Mathilde Funes, Mourey Eric, Michel Frédéric, Cormier Luc
Department of Urology, Hospital of Dijon, University Medical Center, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France,
World J Urol. 2014 Oct;32(5):1235-40. doi: 10.1007/s00345-013-1199-8. Epub 2013 Oct 29.
Because radical prostatectomy with robot-assisted surgery can lead to unwanted prostatic capsular incisions, capsular incision in normal prostatic tissue (CINPT) is not rare. To study the relationship between positive surgical margins (PSM) and CINPT after robot-assisted radical prostatectomy.
From September 2009 to January 2013, 203 consecutive robot-assisted prostatectomies were carried out by the same surgeon. A transperitoneal Montsouris technique was used for all cases, but modified to suit the use of the four-arm DaVinci device. The data were recorded prospectively in our database. Preoperative data were patient's age, body mass index, prostate-specific antigen level, prostate weight, percentage of positive biopsy, clinical stage, and Gleason score. Postoperative data were preservation of the bladder neck and neurovascular bundles (NVB), the presence of extended pelvic lymph-node dissection (ePLND), pathological stage, Gleason score, margin status, blood loss, and operative room times. The CINPT and no-CINPT groups were analysed and compared retrospectively.
The CINPT rates were 23.2 versus 18.2 % for PSM. CINPT contrary to PSM seemed to be more frequent in low-risk prostate cancer. NVB preservation led to more CINPT (p = 0.01). At the multivariate analysis, only the absence of ePLND significantly affected the CINPT status (p = 0.03) and the absence of CINPT positively affected the PSM rate (p = 0.03).
Capsular incision in normal prostatic tissue is not a predictive factor of PSM but reflected risk-taking during surgery especially when NVB preservation is indicated in low-risk prostate cancer. It can therefore only be considered a means to evaluate a surgical technique, but not a real predictor of PSM.
由于机器人辅助手术的根治性前列腺切除术可能导致不必要的前列腺包膜切开，正常前列腺组织中的包膜切开术（CINPT）并不罕见。本研究旨在探讨机器人辅助根治性前列腺切除术后手术切缘阳性（PSM）与CINPT之间的关系。
2009年9月至2013年1月，由同一位外科医生连续进行了203例机器人辅助前列腺切除术。所有病例均采用经腹蒙苏里技术，但进行了改良以适应四臂达芬奇设备的使用。数据前瞻性记录于我们的数据库中。术前数据包括患者年龄、体重指数、前列腺特异性抗原水平、前列腺重量、活检阳性率、临床分期和 Gleason 评分。术后数据包括膀胱颈和神经血管束（NVB）的保留情况、是否存在扩大盆腔淋巴结清扫术（ePLND）、病理分期、Gleason 评分、切缘状态、失血量和手术时间。对CINPT组和非CINPT组进行回顾性分析和比较。
PSM患者的CINPT发生率分别为23.2%和18.2%。与PSM相反，CINPT在低风险前列腺癌中似乎更常见。保留NVB导致更多的CINPT（p = 0.01）。在多变量分析中，仅未进行ePLND显著影响CINPT状态（p = 0.03），而未发生CINPT对PSM率有积极影响（p = 0.03）。
正常前列腺组织中的包膜切开术不是PSM的预测因素，但反映了手术中的风险承担，尤其是在低风险前列腺癌中需要保留NVB时。因此，它只能被视为评估手术技术的一种手段，而不是PSM的真正预测指标。
