在一个腹腔镜经验有限且病例数量有限的中心，对经验丰富的开放前列腺手术外科医生和新手开放手术外科医生进行机器人辅助根治性前列腺切除术临床结果的比较研究。

Comparative investigation on clinical outcomes of robot-assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload.

作者信息

Sumitomo Makoto, Kanao Kent, Kato Yoshiharu, Yoshizawa Takahiko, Watanabe Masahito, Zennami Kenji, Nakamura Kogenta

机构信息

Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.

出版信息

Int J Urol. 2015 May;22(5):469-74. doi: 10.1111/iju.12711. Epub 2015 Feb 26.

DOI:10.1111/iju.12711

PMID:25721437

Abstract

OBJECTIVES

To compare perioperative, oncological and functional outcomes of robot-assisted radical prostatectomy between experienced and novice open radical prostatectomy surgeons in a laparoscopically naïve center with a limited caseload.

METHODS

Six surgeons carried out robot-assisted radical prostatectomy in 154 patients, which were divided into the following three groups: group 1 (n = 90), including patients operated on by a surgeon with experience in both open radical prostatectomy and robot-assisted radical prostatectomy; group 2 (n = 36), including patients operated on by two surgeons with experience in open radical prostatectomy only; and group 3 (n = 28), including patients operated on by three surgeons with limited experience in both open radical prostatectomy or robot-assisted radical prostatectomy.

RESULTS

Groups 2 and 3 did not differ significantly in their median values of external blood loss (P = 0.165) or console time (P = 0.103). Positive surgical margin rates for pT2 patients were also similar in these two groups: 21.2% (7/33) in group 2 and 22.7% (5/22) in group 3 (P = 0.894). Kaplan-Meier analysis showed that 12 months after robot-assisted radical prostatectomy the prostate-specific antigen-free rate for pT2 patients was 96.0% in group 2 and 100% in group 3, but the pad-free continence rate was just 91.0% in group 1, 88.0% in group 2 and 75.5% in group 3 (group 1 vs group 3, P = 0.037; group 2 vs group 3, P = 0.239). The major complication rate after robot-assisted radical prostatectomy was 3.3% (3/90) in group 1, 11.1% (4/36) in group 2 and 17.9% (5/28) in group 3 (group 1 vs group 3, P = 0.008; group 2 vs group 3; P = 0.441).

CONCLUSIONS

Robot-assisted radical prostatectomy offers satisfactory postoperative outcomes even when carried out by surgeons with limited experience in open radical prostatectomy.

摘要

目的

在一个腹腔镜经验有限且病例数量较少的中心，比较经验丰富的开放根治性前列腺切除术外科医生与新手开放根治性前列腺切除术外科医生进行机器人辅助根治性前列腺切除术的围手术期、肿瘤学和功能结果。

方法

6名外科医生对154例患者进行了机器人辅助根治性前列腺切除术，这些患者被分为以下三组：第1组（n = 90），包括由一名既有开放根治性前列腺切除术经验又有机器人辅助根治性前列腺切除术经验的外科医生实施手术的患者；第2组（n = 36），包括由两名仅有开放根治性前列腺切除术经验的外科医生实施手术的患者；第3组（n = 28），包括由三名在开放根治性前列腺切除术或机器人辅助根治性前列腺切除术方面经验有限的外科医生实施手术的患者。

结果

第2组和第3组在术中失血中位数（P = 0.165）或控制台操作时间（P = 0.103）方面无显著差异。这两组中pT2患者的手术切缘阳性率也相似：第2组为21.2%（7/33），第3组为22.7%（5/22）（P = 0.894）。Kaplan-Meier分析显示，机器人辅助根治性前列腺切除术后12个月，第2组pT2患者的无前列腺特异性抗原率为96.0%，第3组为100%，但第1组的无尿垫控尿率仅为91.0%，第2组为88.0%，第3组为75.5%（第1组与第3组比较，P = 0.037；第2组与第3组比较，P = 0.239）。机器人辅助根治性前列腺切除术后的主要并发症发生率在第1组为3.3%（3/90），第2组为11.1%（4/36），第3组为17.9%（5/28）（第1组与第3组比较，P = 0.008；第2组与第3组比较，P = 0.441）。