Jackson Max A, Bellas Nicholas, Siegrist Timothy, Haddock Peter, Staff Ilene, Laudone Vincent, Wagner Joseph R
Urology Division, Hartford Hospital, Hartford, CT.
Urology Service, Middlesex Hospital, Middletown, CT.
Urology. 2016 May;91:111-8. doi: 10.1016/j.urology.2015.12.072. Epub 2016 Feb 12.
To undertake a prospective/retrospective comparison of longer-term oncologic and quality of life outcomes in open radical prostatectomy (ORP) or robotic-assisted laparoscopic radical prostatectomy (RALP) patients.
The clinical progression of ORP and RALP patients who underwent surgery during 2004 was followed over an extended (10 year) period. Pre- and perioperative parameters, oncologic outcomes, recurrence, mortality, and quality of life were compared between surgical modalities. Follow-up time was calculated from the time of surgery to the latest contact. Postoperative quality of life data were obtained from Expanded Prostate Cancer Index Composite survey questionnaires. Recurrence rates, times to recurrence, surgical time, length of stay, hematocrit, follow-up time, and sexual and urinary bother scores were compared between surgical groups. Multivariate analyses were used to predict positive surgical margins and biochemical recurrence.
63 ORP and 116 RALP patients were included (mean age of 60.4 ± 6.4 and 58.6 ± 5.8 years; P = .067), with follow-up times of 10.3 and 10.1 years (P = .191). RALP patients had longer operative times (P < .001), shorter hospital stays (P < .001), and higher discharge hematocrits (P < .001). With prostate-specific antigen, Gleason score, and T-stage as covariates, time to recurrence (P = .365) and positive margin rate (P = .230) were not statistically different between groups. Ninety-five percent of RALP patients were continent and 48.0% were potent vs 92.6% and 41.5% of ORP patients (P = .720; .497). Urinary and sexual bother were not significantly different between groups (P = .392; .985).
Our longer-term follow-up data suggest that ORP and RALP patients have comparable oncologic and quality of life outcomes.
对接受开放性根治性前列腺切除术（ORP）或机器人辅助腹腔镜根治性前列腺切除术（RALP）的患者的长期肿瘤学和生活质量结果进行前瞻性/回顾性比较。
对2004年接受手术的ORP和RALP患者的临床进展进行了长达10年的随访。比较了手术方式之间的术前和围手术期参数、肿瘤学结果、复发、死亡率和生活质量。随访时间从手术时间计算至最近一次联系时间。术后生活质量数据来自扩展前列腺癌指数综合调查问卷。比较了手术组之间的复发率、复发时间、手术时间、住院时间、血细胞比容、随访时间以及性和泌尿系统困扰评分。采用多变量分析来预测手术切缘阳性和生化复发情况。
纳入63例ORP患者和116例RALP患者（平均年龄分别为60.4±6.4岁和58.6±5.8岁；P = 0.067），随访时间分别为10.3年和10.1年（P = 0.191）。RALP患者的手术时间更长（P < 0.001），住院时间更短（P < 0.001），出院时血细胞比容更高（P < 0.001）。以前列腺特异性抗原、Gleason评分和T分期作为协变量，两组之间的复发时间（P = 0.365）和切缘阳性率（P = 0.230）无统计学差异。95%的RALP患者控尿，48.0%性功能保留，而ORP患者分别为92.6%和41.5%（P = 0.720；0.497）。两组之间的泌尿系统和性方面的困扰无显著差异（P = 0.392；0.985）。
我们的长期随访数据表明，ORP和RALP患者在肿瘤学和生活质量结果方面具有可比性。
