Kural Ali Riza, Obek Can, Doganca Tunkut
1 Department of Urology, Acibadem University , Istanbul, Turkey .
2 Department of Urology, Acibadem Taksim Hospital , Istanbul, Turkey .
J Endourol. 2017 Apr;31(S1):S54-S58. doi: 10.1089/end.2016.0585.
Surgical removal with radical prostatectomy has been a cornerstone for the treatment of prostate cancer and is associated with level 1 evidence for survival advantage compared with watchful waiting. Since the first structured robotic program was launched in 2000, robot-assisted radical prostatectomy (RARP) has had a rapid diffusion and surpassed its open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) counterparts in the United States and is progressively expanding in other countries. Interestingly, this common acceptance of RARP was initially driven in the paucity of robust clinical evidence. There is still lack of level 1 evidence with prospective randomized trials on the oncologic outcomes of RARP. In that scenario, the clinician has to rely on retrospective data and systemic and meta-analyses. In comparison with ORP and LRP, RARP has proven to reach at least equivalent oncological outcomes. Lower rate of positive surgical margins may probably be achieved with RARP in pT2 patients. Although urologists were initially reluctant to embrace RARP in high-risk patients and lymph node yield was low, contemporary series have revealed that RARP and extended lymphadenectomy may be safely performed with obtaining similar (or better) nodal yields compared with ORP. Surgeon experience is universally of utmost importance in obtaining good outcomes. We will need to wait for long-term results of contemporary series to comprehend the impact of RARP on cancer-specific survival and overall survival. Using novel imaging before surgery and frozen section analysis during surgery may allow for superior oncological outcomes.
根治性前列腺切除术一直是前列腺癌治疗的基石，与观察等待相比，其生存优势有一级证据支持。自2000年首个结构化机器人手术项目启动以来，机器人辅助根治性前列腺切除术（RARP）迅速普及，在美国已超过开放式根治性前列腺切除术（ORP）和腹腔镜根治性前列腺切除术（LRP），并在其他国家逐步推广。有趣的是，RARP最初被广泛接受时，可靠的临床证据并不充分。目前仍缺乏关于RARP肿瘤学结局的前瞻性随机试验的一级证据。在这种情况下，临床医生不得不依赖回顾性数据以及系统评价和荟萃分析。与ORP和LRP相比，RARP已被证明能达到至少相当的肿瘤学结局。对于pT2期患者，RARP可能实现更低的手术切缘阳性率。尽管泌尿外科医生最初不愿在高危患者中采用RARP，且淋巴结获取率较低，但当代研究表明，与ORP相比，RARP联合扩大淋巴结清扫术可安全进行，且淋巴结获取率相似（或更高）。在取得良好手术效果方面，术者经验至关重要。我们需要等待当代研究的长期结果，以了解RARP对癌症特异性生存和总生存的影响。术前采用新型影像学检查及术中冰冻切片分析可能会带来更好的肿瘤学结局。
