Akita Hidetoshi, Nakane Akihiro, Ando Ryosuke, Yamada Kenji, Kobayashi Takahiro, Okamura Takehiko, Kohri Kejiro
Department of Urology, JA Aichi Anjo Kosei Hospital, Anjo, Japan E-mail :
Asian Pac J Cancer Prev. 2013;14(11):6311-4. doi: 10.7314/apjcp.2013.14.11.6311.
While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma and evaluated the potential advantages of each.
From January 2010 to December 2010, all 23 patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introduced the reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stage prostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serum PSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates and post-operative pain.
There was a significant difference in operative time between the 2-port RP and LRP groups (286.5 ± 63.3 and 351.8 ± 72.4 min: p=0.0019, without any variation in blood loss (including urine) (945.1 ± 479.6 vs 1271.1 ± 871.8 ml: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RP group, but without significance (5.6 ± 1.8 vs 8.0 ± 5.6 days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8 mg/patient in 2-port RP and 50.0mg/patient in LRP.
Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.
虽然五孔腹腔镜根治性前列腺切除术是标准术式，但出于美观考虑，人们一直致力于开发单孔手术。然而，鉴于手术操作的挑战性，这仍处于开创性阶段。因此，我们专注于减少端口手术，仅使用两孔。在本研究中，我们比较了两孔腹腔镜根治性前列腺切除术（2孔RP）和传统五孔腹腔镜根治性前列腺切除术（LRP）治疗临床局限性前列腺癌的效果，并评估了各自的潜在优势。
2010年1月至2010年12月，所有23例临床局限性前列腺癌患者接受了LRP。从2010年11月我们引入减少端口入路开始，我们对22例诊断为早期前列腺癌（cT1c、cT2N0）的患者连续进行了该手术。根据年龄、术前血清PSA水平、临床分期、活检和病理Gleason分级、手术切缘状态、无尿垫率和术后疼痛情况，将患者1:1配对至2孔RP或LRP组。
2孔RP组和LRP组的手术时间存在显著差异（286.5±63.3分钟和351.8±72.4分钟：p = 0.0019），但失血量（包括尿液）无差异（945.1±479.6毫升对1271.1±871.8毫升：p = 0.13）。2孔RP组的Foley导尿管留置期较短，但无统计学意义（5.6±1.8天对8.0±5.6天：p = 0.057），2孔RP和LRP的围手术期总并发症发生率相当，分别为4.5%和8.7%（p = 0.58）。随访至6个月时无尿垫率有所改善（p = 0.090），1年时显著改善（p = 0.040）。2孔RP组的PSA复发率为1例（4.5%），LRP组为2例（8.7%）。大多数LRP患者（95.7%）和早期2孔RP患者（40.9%）使用了连续硬膜外麻醉。在这些患者中，2孔RP组双氯芬酸钠的平均总量为27.8毫克/患者，LRP组为50.0毫克/患者。
因此，减少端口入路在许多结局指标方面与LRP一样有效，具有显著的美观优势且术后疼痛减轻。该方法可以安全简便地实施，因此未来可推荐作为前列腺癌的标准腹腔镜手术。
