Yuksel Mustafa, Karamık Kaan, Anıl Hakan, Islamoglu Ekrem, Ates Mutlu, Savas Murat
Antalya Training and Research Hospital, Antalya.
Arch Ital Urol Androl. 2017 Mar 31;89(1):71-74. doi: 10.4081/aiua.2017.1.71.
After radical prostatectomy, surgical margin positivity is an important indicator of biochemical recurrence and progression. In our study we want to compare the surgical margin positivity rates for retropubic radical prostatectomy (RRP) and robotic assisted radical prostatectomy (RALP) and investigate the factors affecting surgical margin positivity in RALP.
Data from 78 RRP and 62 RALP patients operated from 2011 May to 2016 March were retrospectively screened. Patients in both groups were compared in terms of age, postop hematocrit reduction, hospital stay, duration of follow-up, surgical margin positivity, biochemical recurrence and oncologic parameters. In RALP group it was searched the relationship between the surgical margin positivity and prostate specific antigen (PSA), positive biopsy core, biopsy Gleason scoring, pathologic stage and Gleason scoring, lymph node positivity, lymphovascular and perineural invasion, extracapsular extension, seminal vesicle invasion, prostate weight.
Patients in the RALP group had lower postop hematocrit reduction and shorter hospital stay (p < 0.001). There was no difference in surgical margin positivity between RALP and RRP groups (37.1% vs. 29.5%, p = 0.341). In RALP group there was a correlation between surgical margin positivity and positive biopsy core number (p = 0.011), pathologic stage (p < 0.001) and Gleason score (p < 0.001), EAU risk classification (p = 0.001), seminal vesicle invasion (p = 0.045), extraprostatic extension (p < 0.001). There was no correlation between prostate weight (p = 0.896), PSA (p = 0.220), biopsy Gleason score (p = 0.266), lymph node positivity (p = 0.140), perineural (p = 0.103) and lymphovascular invasion (p = 0.92) with surgical margin positivity.
Positive biopsy core number, pathological stage and Gleason score, EAU risk classification, seminal vesicle invasion and extraprostatic extension are correlated with surgical margin positivity in RALP.
根治性前列腺切除术后，手术切缘阳性是生化复发和疾病进展的重要指标。在本研究中，我们旨在比较耻骨后根治性前列腺切除术（RRP）和机器人辅助根治性前列腺切除术（RALP）的手术切缘阳性率，并探究影响RALP手术切缘阳性的因素。
回顾性筛选2011年5月至2016年3月期间接受手术的78例RRP患者和62例RALP患者的数据。比较两组患者的年龄、术后血细胞比容降低情况、住院时间、随访时长、手术切缘阳性情况、生化复发及肿瘤学参数。在RALP组中，研究手术切缘阳性与前列腺特异性抗原（PSA）、阳性活检核心、活检Gleason评分、病理分期及Gleason评分、淋巴结阳性、淋巴管和神经周围浸润、包膜外扩展、精囊侵犯、前列腺重量之间的关系。
RALP组患者术后血细胞比容降低幅度较小，住院时间较短（p < 0.001）。RALP组和RRP组的手术切缘阳性率无差异（37.1%对29.5%，p = 0.341）。在RALP组中，手术切缘阳性与阳性活检核心数量（p = 0.011）、病理分期（p < 0.001）、Gleason评分（p < 0.001）、欧洲泌尿外科协会（EAU）风险分类（p = 0.001）、精囊侵犯（p = 0.045）、前列腺外扩展（p < 0.001）相关。前列腺重量（p = 0.896）、PSA（p = 0.220）、活检Gleason评分（p = 0.266）、淋巴结阳性（p = 0.140）、神经周围（p = 0.103）及淋巴管侵犯（p = 0.92）与手术切缘阳性无相关性。
阳性活检核心数量、病理分期、Gleason评分、EAU风险分类、精囊侵犯和前列腺外扩展与RALP手术切缘阳性相关。
