Antonelli Alessandro, Sodano Mario, Peroni Angelo, Mittino Irene, Palumbo Carlotta, Furlan Maria, Carobbio Francesca, Tardanico Regina, Fisogni Simona, Simeone Claudio
Urology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy -
Urology Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
Minerva Urol Nefrol. 2017 Feb;69(1):63-68. doi: 10.23736/S0393-2249.16.02518-2. Epub 2016 Mar 9.
The aim of this study was to analyze the rates of positive surgical margins (PSM) after radical prostatectomy in patients undergoing robotic surgery (robot assisted laparoscopic prostatectomy [RALP]) compared with those undergoing open surgery (radical retropubic prostatectomy [RRP]), at an institution with medium case load.
Retrospective consultation of a perspectively-maintained database that stores the data of all the patients submitted to radical prostatectomy at our institution since 1/2008. The indication to RRP vs. RALP was based almost exclusively on the period of the study: RRP was the sole available option between 1/2008 and 3/2010 and afterwards RALP become the standard of treatment, once a learning curve of 50 cases was concluded. A PSM was defined as the presence of cancer at the inked surface of prostate. A univariate and multivariate binary logistic regression estimated which factors were related to PSMs.
The data of 576 patients (285 RRP, 291 RALP) were evaluated. The overall PSM rate was 28.1% (162/414 patients; 20.6% for pT2 stage, 51.8% for pT>2); overall PSM rate for RRP vs. RALP was 31.9% vs. 24.4 % (P=0.044). At multivariable analysis the factors related to the risk of PSM were stage pT>2 (RR 2.979, P=0.001), Gleason Score >6 (RR 1.662, P=0.026), the volume of tumor (RR 1.019, P=0.008) and the surgical technique (RALP vs. RRP, RR 0.647, P=0.039).
In a series from a medium case-load institution, once data are adjusted for local staging, tumor volume and Gleason score, the risk of PSM is lower for RALP than RRP. This evidence could be of support for health-care practitioners to introduce robotic systems.
本研究旨在分析在一家病例数量中等的机构中，接受机器人手术（机器人辅助腹腔镜前列腺切除术[RALP]）的患者与接受开放手术（耻骨后根治性前列腺切除术[RRP]）的患者相比，根治性前列腺切除术后切缘阳性（PSM）的发生率。
回顾性查阅一个前瞻性维护的数据库，该数据库存储了自2008年1月以来在本机构接受根治性前列腺切除术的所有患者的数据。RRP与RALP的选择几乎完全基于研究时期：在2008年1月至2010年3月期间，RRP是唯一可用的选择，之后，在完成50例的学习曲线后，RALP成为治疗标准。PSM定义为前列腺墨水标记表面存在癌细胞。单因素和多因素二元逻辑回归分析估计哪些因素与PSM相关。
评估了576例患者的数据（285例RRP，291例RALP）。总体PSM发生率为28.1%（162/414例患者；pT2期为20.6%，pT>2期为51.8%）；RRP与RALP的总体PSM发生率分别为31.9%和24.4%（P = 0.044）。多因素分析显示，与PSM风险相关的因素包括pT>2期（RR 2.979，P = 0.001）、Gleason评分>6（RR 1.662，P = 0.026）、肿瘤体积（RR 1.019，P = 0.008）和手术技术（RALP与RRP相比，RR 0.647，P = 0.039）。
在一个病例数量中等的机构系列研究中，一旦对局部分期、肿瘤体积和Gleason评分进行数据调整，RALP的PSM风险低于RRP。这一证据可为医疗从业者引入机器人系统提供支持。
