Kočárek J, Heráček J, Čermák M, Chmelík F, Matějková M
Rozhl Chir. 2017 Winter;96(2):75-81.
Prostate cancer is the most common malignant disease in men. The number of cases of prostate cancer has increased dramatically in recent 20 years. Radical prostatectomy is a surgical method for the first-line treatment of localised prostate cancer. We performed the first robotic-assisted radical prostatectomy on December 16th, 2005, achieved the boundary of 1000 robotic-assisted radical prostatectomies in 2012, and in 2015, we successfully completed the 1500th robotic-assisted operation on the prostate.
We retrospectively evaluated the oncological and functional results in 1,500 consecutive patients who underwent robotic-assisted radical prostatectomy at our institution between 20052015. The robotic system da Vinci Standard was used for the operations until November 2013, and subsequently the robotic system da Vinci Si HD. Mean age of the patients was 63.7 years (40 to 86); mean BMI was 27.7 (19.4 to 41.4); and mean preoperative PSA was 6.7 ng/ml (0.4 to 112.0).
Pathological stage of the localised prostate cancer was found in 1125 (75%) men, and the stage of locally advanced cancer was found in 363 (24.2%) patients. We determined the Gleason score 7 in surgical specimens of 1150 (76.7%) men. 171 (11.4%) men underwent pelvic lymphadenectomy; metastases in the pelvic lymph nodes were detected in 36 (21.1%) patients. Urinary continence in the period of up to 1 year after the surgery was evaluated in 1218 (81.2%) patients in the group. 1119 (91.9%) men needed no incontinence pads or one safety pad one year from the surgery. Postoperative erectile function was evaluated in 447 (29.8%) men. One year from the surgery, 247 (55.3%) men were capable of a sufficient erection for sexual intercourse without any supportive therapy. Intraoperative complications according to the Clavien-Dindo classification were observed in 20 (1.3%) patients; complications within 3 months from the surgery were observed in 127 (8.5%) patients.
Robotic-assisted radical prostatectomy is a clearly defined, safe and reproducible minimally invasive treatment of localised prostate cancer.Key words: prostate cancer robotic surgery radical prostatectomy complications.
前列腺癌是男性最常见的恶性疾病。近20年来，前列腺癌病例数急剧增加。根治性前列腺切除术是局限性前列腺癌一线治疗的手术方法。我们于2005年12月16日开展了首例机器人辅助根治性前列腺切除术，2012年达到1000例机器人辅助根治性前列腺切除术的规模，2015年，我们成功完成了第1500例前列腺机器人辅助手术。
我们回顾性评估了2005年至2015年间在我院接受机器人辅助根治性前列腺切除术的1500例连续患者的肿瘤学和功能结果。2013年11月之前的手术使用达芬奇标准机器人系统，随后使用达芬奇Si HD机器人系统。患者的平均年龄为63.7岁（40至86岁）；平均体重指数为27.7（19.4至41.4）；术前平均前列腺特异性抗原为6.7 ng/ml（0.4至112.0）。
1125名（75%）男性被发现患有局限性前列腺癌的病理分期，363名（24.2%）患者被发现患有局部晚期癌症分期。我们在1150名（76.7%）男性的手术标本中确定了Gleason评分为7分。171名（11.4%）男性接受了盆腔淋巴结清扫术；36名（21.1%）患者在盆腔淋巴结中检测到转移。该组中1218名（81.2%）患者在术后长达1年的时间内接受了尿失禁评估。1119名（91.9%）男性在术后1年内不需要使用尿失禁垫或仅需使用一个安全垫。447名（29.8%）男性接受了术后勃起功能评估。术后1年，247名（55.3%）男性在无需任何辅助治疗的情况下能够有足够的勃起进行性交。根据Clavien-Dindo分类，20名（1.3%）患者出现术中并发症；127名（8.5%）患者在术后3个月内出现并发症。
机器人辅助根治性前列腺切除术是一种明确、安全且可重复的局限性前列腺癌微创治疗方法。关键词：前列腺癌；机器人手术；根治性前列腺切除术；并发症
