Verze Paolo, Greco Francesco, Scuzzarella Salvatore, Bottone Francesco, Palmieri Alessandro, Cucchiara Vito, Arcaniolo Davide, Imperatore Vittorio, Creta Massimiliano, Mirone Vincenzo
Urology Unit, Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples "Federico II ", Naples, Italy -
Urology and Mini-Invasive Surgery Unit, Romolo Hospital, Rocca di Neto, Crotone, Italy.
Minerva Urol Nefrol. 2017 Feb;69(1):76-84. doi: 10.23736/S0393-2249.16.02612-6. Epub 2016 Jun 29.
The aim of this study was to evaluate the outcomes in laparoscopic radical prostatectomy (LRP) in patients who had undergone prior prostate surgery (PPS).
In this study 946 consecutive LR P patients were included and a retrospective comparison between those patients who had received PPS (group A) and those who had not received PPS (group B) was carried out. The preoperative, intraoperative and postoperative data was collected in a prospectively-maintained database. All complications occurring ≤30 days after surgery were recorded and defined according to the Dindo-modification of the Clavien system.
Longer operative time, greater blood loss, longer catheterization time, higher incidence of lymphocele, rectal injury and anastomotic stricture were found to be more frequent in group A. No statistically significant difference was noted between the two groups in terms of positive surgical margin rate and Biochemical recurrence free survival (BCRFS). Complete urinary continence rate resulted significantly higher in group B patients at both 1-year and 2-year follow-up. Potency rate resulted better in group B patients even if a statistically significant difference for both unilateral and bilateral nerve sparing techniques was not reached.
LRP procedure can be safely performed on patients who have previously undergone PPS without compromising oncologic safety whereas a negative impact on functional outcome in terms of achieving a complete urinary continence rate and sexual potency should be expected.
本研究的目的是评估既往接受过前列腺手术（PPS）的患者行腹腔镜根治性前列腺切除术（LRP）的结果。
本研究纳入了946例连续的LRP患者，并对接受PPS的患者（A组）和未接受PPS的患者（B组）进行了回顾性比较。术前、术中和术后数据收集于一个前瞻性维护的数据库中。记录所有术后≤30天发生的并发症，并根据Clavien系统的Dindo改良版进行定义。
发现A组手术时间更长、失血量更大、导尿时间更长、淋巴囊肿、直肠损伤和吻合口狭窄的发生率更高。两组在手术切缘阳性率和无生化复发生存率（BCRFS）方面无统计学显著差异。在1年和2年随访时，B组患者的完全尿控率显著更高。即使在单侧和双侧神经保留技术方面未达到统计学显著差异，B组患者的性功能恢复率仍更好。
LRP手术可以安全地在既往接受过PPS的患者身上进行，而不会影响肿瘤学安全性，然而，预计在实现完全尿控率和性功能方面对功能结果会有负面影响。
