Ubrig Burkhard, Boy Anselm, Heiland Markus, Roosen Alexander
1 Department of Urology, Augusta-Kliniken Bochum , Germany .
2 Witten/Herdecke University , Witten/Herdecke, Germany .
J Endourol. 2018 Feb;32(2):106-110. doi: 10.1089/end.2017.0512. Epub 2018 Jan 24.
We set out to evaluate outcomes in patients over 74 after robotic radical prostatectomy.
Six hundred forty-seven patients over 74 (≥75) were analyzed for preoperative factors (body mass index [BMI], American Society of Anestesiologists classification [ASA], prostate-specific antigen [PSA], International prostate symptome score [IPSS], International index of erectile function [IIEF]), operative and perioperative characteristics (technique, erythrocyte conc., complications), and histopathological results. After 12 months, following items were assessed: PSA, frequency of urine loss, number of pads used (including safety), incontinence at night, and potency as quantified by IIEF-5.
Mean age in the group <75 was 64.8 years (range 46-74 years) and in the group ≥75 76.9 years (75-88). No statistically significant differences could be detected in terms of BMI, ASA score, or preoperative PSA, respectively. IPSS and IIEF were significantly worse in the group ≥75. Major complications (>Clavien-Dindo III) were found in 1.6% vs. 1.3% (≥75) of cases. Minor complications were encountered in 22.8% vs. 26.3% (≥75). There was a remarkably high percentage of locally advanced disease (73.3% vs. 71.0%) in both groups. Patients ≥75 showed a tendency toward more aggressive cancer and more frequent nodal involvement; we found a higher percentage of R1-resections (19.5% vs. 30.4%, p < 0.05) and PSA relapse after 1 year (12.3% vs. 22.8%, p < 0.05). Twelve months pad-free continence rate (69.9% vs. 63.2%) showed no statistically significant difference between both groups as did the preservation rate of erectile function.
We could show that robotic prostatectomy can be carried out safely with good functional and histopathological results in patients ≥75. It is therefore questionable if elderly patients can be precluded from curative radical treatment solely because of their age.
我们着手评估74岁以上患者接受机器人根治性前列腺切除术后的疗效。
分析了647例74岁以上（≥75岁）患者的术前因素（体重指数[BMI]、美国麻醉医师协会分级[ASA]、前列腺特异性抗原[PSA]、国际前列腺症状评分[IPSS]、国际勃起功能指数[IIEF]）、手术及围手术期特征（技术、红细胞浓度、并发症）以及组织病理学结果。12个月后，评估以下项目：PSA、尿失禁频率、使用尿垫数量（包括安全尿垫）、夜间尿失禁以及通过IIEF-5量化的勃起功能。
<75岁组的平均年龄为64.8岁（范围46 - 74岁），≥75岁组为76.9岁（75 - 88岁）。在BMI、ASA评分或术前PSA方面，未检测到统计学上的显著差异。≥75岁组的IPSS和IIEF明显更差。主要并发症（>Clavien-Dindo III级）在<75岁组和≥75岁组中的发生率分别为1.6%和1.3%。轻微并发症的发生率在<75岁组和≥75岁组中分别为22.8%和26.3%。两组局部晚期疾病的比例都非常高（分别为73.3%和71.0%）。≥75岁的患者表现出癌症更具侵袭性且淋巴结受累更频繁的趋势；我们发现R1切除率更高（19.5%对30.4%，p < 0.05），1年后PSA复发率也更高（12.3%对22.8%，p < 0.05）。两组的12个月无尿垫尿失禁率（69.9%对63.2%）以及勃起功能保留率均无统计学上的显著差异。
我们可以证明，对于≥75岁的患者，机器人前列腺切除术可以安全进行，并且具有良好的功能和组织病理学结果。因此，仅因年龄因素就将老年患者排除在根治性治疗之外是否合理值得质疑。
