Duperron C, Moulin M, Koutlidis N, Mourey E, Cormier L
Service d'urologie, hôpital Le Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
Service d'urologie, hôpital Le Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
Prog Urol. 2015 Jun;25(7):390-5. doi: 10.1016/j.purol.2015.02.003. Epub 2015 Mar 7.
To evaluate the feasibility of robot-assisted radical prostatectomy (RARP) in high risk prostate cancer (HR). The rate of positive surgical margins (PSM) was compared between anticipated HR cancer according to D'Amico risk classification and discovered postoperative HR cancer.
A retrospective study was conducted between 2006 and 2013 on patients who underwent RARP. Before surgery, patients were divided according to the D'Amico risk classification. After surgery, HR was defined as pT3a or pT3b, or Gleason score≥8 or positive lymph nodes. The rate of PSM was compared according to the D'Amico risk classification and postoperative HR.
During the study, 485 patients were reviewed. Before surgery, 10 % of cancers were classified as D'Amico 3 (49/485). After surgery, 27.6 % (134/485) were classified as HR. There was a significant difference between the rate of PSM in HR/D'Amico 3 and HR/non D'Amico 3 cancer, respectively 22.9 % and 34.3 % (P<0.001).
The RARP is feasible in HR with an average of 30 % of PSM as in open surgery. However, the accurate assessment of preoperative HR will allow a more adapted dissection and a decrease of rate of PSM. So it is necessary to improve the detection of HR and so to select the most suitable cancer for surgery.
Level 5.
评估机器人辅助根治性前列腺切除术（RARP）在高危前列腺癌（HR）中的可行性。比较根据达米科风险分类预期的HR癌与术后发现的HR癌的手术切缘阳性（PSM）率。
对2006年至2013年期间接受RARP的患者进行回顾性研究。手术前，根据达米科风险分类对患者进行分组。手术后，HR定义为pT3a或pT3b，或Gleason评分≥8或淋巴结阳性。根据达米科风险分类和术后HR比较PSM率。
研究期间，共回顾了485例患者。手术前，10%的癌症被分类为达米科3级（49/485）。手术后，27.6%（134/485）被分类为HR。HR/达米科3级和HR/非达米科3级癌症的PSM率分别为22.9%和34.3%，差异有统计学意义（P<0.001）。
RARP在HR中是可行的，PSM平均率与开放手术相同，为30%。然而，术前对HR的准确评估将有助于更合适的解剖并降低PSM率。因此，有必要改进HR的检测，从而选择最适合手术的癌症。
5级。
