Albisinni Simone, Aoun Fouad, LE Dinh Dam, Zanaty Marc, Hawaux Eric, Peltier Alexandre, VAN Velthoven Roland
Department of Urology, Institut Jules Bordet, Bruxelles, Belgium -
Department of Urology, Institut Jules Bordet, Bruxelles, Belgium.
Minerva Urol Nefrol. 2017 Feb;69(1):101-107. doi: 10.23736/S0393-2249.16.02799-5. Epub 2016 Nov 10.
In intermediate and high-risk prostate cancer patients, a robotic-assisted approach is increasingly being used for prostatectomy and extended pelvic lymph node dissection (ePLND). This is reducing the number of conventional laparoscopic radical prostatectomies (LR P) and laparoscopic ePLNDs for prostate cancer in Europe. Aim of this study is to compare laparoscopic ePLND to robotic-assisted ePLND in a cohort of patients with intermediate and high risk prostate cancer.
We performed a matched-pair analysis matching 1:1 70 patients who underwent LRP+ePLND (2004-2009) to 70 who underwent RAR P+ePLND (2010-2014). All patients presented with intermediate or high-risk prostate cancer according to D'Amico classification. Patients were retrospectively analyzed. Differences in pathologic characteristics and postoperative complications across the two groups were assessed using Wilcoxon Rank sum or χ2 Test.
LRP was associated with shorter OR times and decreased blood loss (P<0.001). However, in the robotic-assisted arm, more lymph nodes were retrieved (18 vs. 12; P<001). No significant difference in positive surgical margins was found across the two techniques (P=0.9). Lymphocele formation and prolonged lymphorrea were specifically addressed as complications, with no significant difference emerging from our analyses (P>0.74).
In this matched-pair analysis comparing patients with intermediate and high-risk prostate cancer, a robotic-assisted approach was associated to a higher lymph node yield compared to conventional laparoscopy. However, this increase in node yield was balanced with longer OR times, increased blood loss, similar postoperative complications and similar oncologic outcomes. Larger and prospective studies in patients at high risk are necessary to validate these findings.
在中高危前列腺癌患者中，机器人辅助方法越来越多地用于前列腺切除术和扩大盆腔淋巴结清扫术（ePLND）。这正在减少欧洲用于前列腺癌的传统腹腔镜根治性前列腺切除术（LRP）和腹腔镜ePLND的数量。本研究的目的是在一组中高危前列腺癌患者中比较腹腔镜ePLND和机器人辅助ePLND。
我们进行了一项配对分析，将70例行LRP+ePLND（2004 - 2009年）的患者与70例行机器人辅助根治性前列腺切除术（RARP）+ePLND（2010 - 2014年）的患者按1:1进行匹配。所有患者根据达米科分类法表现为中高危前列腺癌。对患者进行回顾性分析。使用Wilcoxon秩和检验或χ2检验评估两组之间病理特征和术后并发症的差异。
LRP与较短的手术时间和较少的失血量相关（P<0.001）。然而，在机器人辅助组中，切除的淋巴结更多（18个对12个；P<0.01）。两种技术在手术切缘阳性方面未发现显著差异（P = 0.9）。淋巴囊肿形成和淋巴漏延长被特别作为并发症处理，我们的分析未发现显著差异（P>0.74）。
在这项比较中高危前列腺癌患者的配对分析中，与传统腹腔镜检查相比，机器人辅助方法与更高的淋巴结获取率相关。然而，淋巴结获取率的增加与更长的手术时间、更多的失血量、相似的术后并发症和相似的肿瘤学结果相平衡。有必要对高危患者进行更大规模的前瞻性研究来验证这些发现。
