Gárate J, Sánchez-Salas R, Valero R, Matheus R, León A, Dávila H
Unidad de Cirugía Robótica, Servicio de Urología, Hospital Universitario de Caracas, Caracas, Venezuela.
Unidad de Cirugía Robótica, Servicio de Urología, Hospital Universitario de Caracas, Caracas, Venezuela.
Actas Urol Esp. 2015 Jan-Feb;39(1):20-5. doi: 10.1016/j.acuro.2013.12.014. Epub 2014 Jun 25.
Radical prostatectomy (RP) is the standard treatment for cancer control in the long term. The rise of minimally invasive surgery and new technologies have yielded better results and enabled us to pursue more ambitious objectives. The main works still use the trifecta as classic presentation, but this does not cover all aspects of surgery. Pentafecta is a new and more comprehensive methodology to report outcomes after RP, including complications and surgical margin status with the three major outcomes classically reported. The purpose of this study is to report our experience with robot-assisted laparoscopic radical prostatectomy (RALRP) by applying the concept of pentafecta.
Describe the experience in this institution from March 2009 to December 2012 of RALRP by pentafecta.
We performed 101 interventions and obtained the following results: Average age 60.89 ± 7.32 years (40-77), total PSA 8.5 ± 5.57 ng/dl (0.2-29); D'Amico classification: Low 29 (28.71%), Medium 65 (64.36%), High 7 (6.93%); Operative time 253.44 ± 51.51 min (90-540), Complications 12.9% (Clavien I-II 10.89% and Clavien IIIa 1.98%); Positive surgical margins 20.83%; Biochemistry recurrence 12.5% follow-up (6-44 months); and Continence 87.5% per year and Potency 59.52%.
RALRP is a safe and reproducible procedure with excellent results in terms of pentafecta, inclusive during the initial experience at a low volumen center for prostate cancer. A longer follow-up study and experience with higher volume of patients are required to obtain better results and data to be compared with excellence centers.
根治性前列腺切除术（RP）是长期控制癌症的标准治疗方法。微创手术和新技术的兴起取得了更好的效果，使我们能够追求更宏伟的目标。主要研究仍将“三连胜”作为经典指标，但这并未涵盖手术的所有方面。“五连胜”是一种更新的、更全面的方法，用于报告RP术后的结果，包括并发症和手术切缘状态以及传统报告的三大主要结果。本研究的目的是通过应用“五连胜”概念报告我们在机器人辅助腹腔镜根治性前列腺切除术（RALRP）方面的经验。
描述2009年3月至2012年12月在本机构采用“五连胜”进行RALRP的经验。
我们进行了101例手术，获得以下结果：平均年龄60.89±7.32岁（40 - 77岁），总前列腺特异性抗原（PSA）8.5±5.57 ng/dl（0.2 - 29）；达米科分类：低危29例（28.71%），中危65例（64.36%），高危7例（6.93%）；手术时间253.44±51.51分钟（90 - 540分钟），并发症发生率12.9%（Clavien I - II级10.89%，Clavien IIIa级1.98%）；手术切缘阳性率20.83%；生化复发率随访期间为12.5%（6 - 44个月）；控尿率每年87.5%，勃起功能保留率59.52%。
RALRP是一种安全且可重复的手术，在“五连胜”方面效果优异，包括在前列腺癌低手术量中心的初期经验。需要进行更长时间的随访研究以及更多患者的经验，以获得更好的结果和数据，与优秀中心进行比较。
