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[75岁及以上男性的机器人辅助根治性前列腺切除术]

[ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR MEN AGE 75 AND OLDER].

作者信息

Sasaki Yutaro, Shiozaki Keito, Miyake Takeshi, Izumi Kazuyoshi, Kishimoto Tomoteru, Yamanaka Masahito, Kawanishi Yasuo

机构信息

Department of Urology, Takamatsu Red Cross Hospital.

出版信息

Nihon Hinyokika Gakkai Zasshi. 2017;108(1):12-16. doi: 10.5980/jpnjurol.108.12.

Abstract

(Objectives) Surgical treatment prostate cancer in elderly patients is controversial. However, robot-assisted radical prostatectomy (RARP) is a less invasive procedure than conventional surgery. Therefore, we perform RARP for elderly patients whose general condition is good (Performance status ≤1). The aim of this study is to evaluate surgical, oncological and functional outcomes for RARP in men age 75 and older. (Patients and methods) From July 2013 to April 2016, 300 patients underwent RARP at our institution. They were divided into two groups: an older patient group (≥75 years) and a younger patient group (<75 years). Treatment outcomes for each group, including surgical, oncological and functional outcomes, were compared. (Results) There were no statistically significant differences in surgical outcomes with the exception of nerve sparing rates (older patients: 5.9% vs. younger patients: 17.7%, P=0.0192). Importantly, intra- and postoperative complication rates were similar in both groups (minor complication: 7.4% vs. 3.9%, P=0.322, major complication: 0.0% vs. 2.2%, P=0.592). Regarding oncological outcomes, including positive surgical margin rate and PSA failure (PSA>0.2 ng/ml) at 12 months after surgery, no significant differences existed. Lastly, functional outcomes between the groups, including continence (≤1 pads/day) at 12 months after surgery, had no significant differences. (Conclusions) Our data suggests that RARP can be performed safely for men age 75 and older, and can become a good option for older patients with prostate cancer.

摘要

(目的)老年患者前列腺癌的手术治疗存在争议。然而,机器人辅助根治性前列腺切除术(RARP)比传统手术的侵入性更小。因此,我们对一般状况良好(体能状态≤1)的老年患者实施RARP。本研究的目的是评估75岁及以上男性接受RARP后的手术、肿瘤学和功能结局。(患者与方法)2013年7月至2016年4月,300例患者在我院接受了RARP。他们被分为两组:老年患者组(≥75岁)和年轻患者组(<75岁)。比较了每组的治疗结局,包括手术、肿瘤学和功能结局。(结果)除保留神经率外,手术结局无统计学显著差异(老年患者:5.9% vs. 年轻患者:17.7%,P = 0.0192)。重要的是,两组的术中及术后并发症发生率相似(轻微并发症:7.4% vs. 3.9%,P = 0.322,严重并发症:0.0% vs. 2.2%,P =0.592)。关于肿瘤学结局,包括手术切缘阳性率和术后12个月时的PSA失败(PSA>0.2 ng/ml),不存在显著差异。最后,两组之间的功能结局,包括术后12个月时的控尿情况(≤1片/天),无显著差异。(结论)我们的数据表明,75岁及以上男性可以安全地接受RARP,并且RARP可以成为老年前列腺癌患者的一个良好选择。

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