Department of Urology, Washington Hospital Center, Washington, DC, USA ; Department of Urology, Georgetown University Hospital, Washington, DC, USA.
Prostate Int. 2013;1(1):31-6. doi: 10.12954/PI.12001. Epub 2013 Jan 21.
Robotic-assisted laparoscopic prostatectomy (RALP) offers reportedly comparable oncologic outcomes for localized disease compared with open radical retropubic prostatectomy (ORRP). However, the oncologic efficacy of RALP in locally-advanced prostate cancer (PCa) is less clear. We report and compare our experience with RALP and ORRP in men with locally advanced PCa.
Patients with locally advanced PCa (stage T3 or greater) were identified in both robotic and open cohorts. Clinicopathologic features including age, clinical stage, prostate-specific antigen, surgical margins, and Gleason score were reviewed. We further examined the incidence of positive surgical margins, the effect of the surgical learning curve on margins, and the need for adjuvant therapy.
From 1997 to 2010, 1,011 patients underwent RALP and 415 patients were identified who underwent radical retropubic prostatectomy (RRP) across four institutions. 140 patients in the RALP group and 95 in the RRP group had locally advanced PCa on final pathology. The overall robotic positive margin rate 47.1% compared with 51.4% in the RRP group. A trend towards a lower positive margin rate was seen after 300 cases in the RALP group, with 66.7% positive margin rate in the first 300 cases compared with 41.8% in the latter 700 cases. In addition, a lower incidence of biochemical recurrence was also noted in the latter cases (30.6% vs. 9.5%).
Up to 2 out of 3 men undergoing RALP for locally-advanced PCa had positive margins during our initial experience. However, with increasing surgeon experience the overall positive margin rate decreased significantly and was comparable to the positive margin rate for patients with locally advanced disease undergoing ORRP over four academic institutions. We also noted a lower incidence of biochemical recurrence with increasing RALP experience, suggesting better oncologic outcomes with higher volume. Given this data, RALP has comparable oncologic outcomes compared to ORRP, especially with higher volume surgeons.
机器人辅助腹腔镜前列腺切除术（RALP）与开放性根治性耻骨后前列腺切除术（ORRP）相比，据称可为局限性疾病提供相当的肿瘤学结果。然而，RALP 在局部进展性前列腺癌（PCa）中的肿瘤学疗效尚不清楚。我们报告并比较了我们在局部晚期前列腺癌患者中使用 RALP 和 ORRP 的经验。
在机器人和开放队列中均确定了局部晚期 PCa（T3 期或更高）的患者。回顾了临床病理特征，包括年龄、临床分期、前列腺特异性抗原、手术切缘和 Gleason 评分。我们进一步检查了阳性手术切缘的发生率、手术学习曲线对切缘的影响以及辅助治疗的需要。
从 1997 年到 2010 年，有 1011 名患者接受了 RALP，在四个机构中发现了 415 名接受了根治性耻骨后前列腺切除术（RRP）的患者。RALP 组中有 140 名患者和 RRP 组中有 95 名患者在最终病理上患有局部晚期 PCa。总体机器人阳性切缘率为 47.1%，而 RRP 组为 51.4%。RALP 组中 300 例后，阳性切缘率呈下降趋势，前 300 例的阳性切缘率为 66.7%，后 700 例为 41.8%。此外，在后一组中也观察到生化复发的发生率较低（30.6%比 9.5%）。
在我们最初的经验中，多达 2/3 的接受 RALP 治疗局部晚期 PCa 的男性存在阳性切缘。然而，随着外科医生经验的增加，总体阳性切缘率显著下降，与在四个学术机构接受局部晚期疾病 ORRP 的患者的阳性切缘率相当。我们还注意到，随着 RALP 经验的增加，生化复发的发生率也降低，提示高容量具有更好的肿瘤学结果。鉴于这些数据，RALP 与 ORRP 的肿瘤学结果相当，尤其是在具有更高容量的外科医生中。
