机器人辅助根治性前列腺切除术在适合主动监测的患者中的功能结局。
Functional outcomes of robot-assisted radical prostatectomy in patients eligible for active surveillance.
机构信息
Department of Surgery, Université de Montréal, Montreal, QC, Canada.
Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Cœur de Montréal, Montreal, QC, Canada.
出版信息
World J Urol. 2018 Sep;36(9):1391-1397. doi: 10.1007/s00345-018-2298-3. Epub 2018 Apr 21.
OBJECTIVE
To assess the outcome of low risk prostate cancer (PCa) patients who were candidates for active surveillance (AS) but had undergone robot-assisted radical prostatectomy (RARP).
METHOD
We reviewed our prospectively collected database of patients operated by RARP between 2006 and 2014. Low D'Amico risk patients were selected. Oncological outcomes were reported based on pathology results and biochemical failure. Functional outcomes on continence and potency were reported at 12 and 24 months. Continence was assessed by the number of pads per day. With respect to potency, it was assessed using the Sexual Health Inventory for Men (SHIM) and Erectile Hardness Scale (EHS).
RESULTS
Out of 812 patients, 237 (29.2%) patients were D'Amico low risk and were eligible for analysis. 44 men fit Epstein's criteria. 134 (56.5%) men had pathological upgrading. Age and clinical stage were predictors of upgrading on multivariate analysis. 220 (92.8%) patients had available follow-up for biochemical recurrence, potency, and continence for 2 years. The mean and median follow-up was 34.8 and 31.4 months, respectively. Only 5 (2.3%) men developed BCR, all of whom had pathological upgrading. Extra capsular extension and positive surgical margins were observed in 14.8 and 19.1%, respectively. 0 pad was achieved in 86.7 and 88.9% at 1 and 2 years, respectively. Proportion of patients with SHIM > 21 at 1 and 2 years was 24.8 and 30.6%, respectively. Moreover, patients having erections adequate for intercourse (EHS ≥ 3) were seen in 69.6 and 83.1% at 1 and 2 years, respectively. Functional outcomes of patients fitting Epstein's criteria (n = 44) and patients with no upgrading on final pathology (n = 103) were not significantly different compared to the overall low risk study group.
CONCLUSION
This retrospective study showed that RARP is not without harm even in patients with low risk disease. On the other hand, considerable rate of upgrading was noted.
目的
评估适合主动监测（AS）但接受机器人辅助根治性前列腺切除术（RARP）的低危前列腺癌（PCa）患者的结局。
方法
我们回顾了 2006 年至 2014 年间接受 RARP 手术的患者前瞻性收集的数据库。选择低 D'Amico 风险患者。根据病理结果和生化失败报告肿瘤学结局。在 12 个月和 24 个月时报告控尿和勃起功能的功能结局。通过每天使用尿垫的数量评估控尿情况。至于勃起功能，使用男性性健康问卷（SHIM）和勃起硬度量表（EHS）进行评估。
结果
在 812 名患者中，237 名（29.2%）患者为 D'Amico 低危，符合分析条件。44 名患者符合 Epstein 标准。134 名（56.5%）患者存在病理升级。年龄和临床分期是多变量分析中升级的预测因素。220 名（92.8%）患者有 2 年的生化复发、勃起功能和控尿的随访。平均和中位随访时间分别为 34.8 个月和 31.4 个月。仅 5 名（2.3%）患者发生 BCR，均有病理升级。在 14.8%和 19.1%的患者中观察到包膜外扩展和阳性切缘。1 年和 2 年时分别有 86.7%和 88.9%的患者使用 0 个尿垫。1 年和 2 年时，SHIM>21 的患者比例分别为 24.8%和 30.6%。此外，在 1 年和 2 年时，有勃起功能足以进行性交的患者（EHS≥3）分别为 69.6%和 83.1%。与总体低危研究组相比，符合 Epstein 标准的患者（n=44）和最终病理无升级的患者（n=103）的功能结局无显著差异。
结论
这项回顾性研究表明，即使在低危疾病患者中，RARP 也并非没有危害。另一方面，注意到相当高的升级率。
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