1 College of Medicine, University of Nebraska Medical Center , Omaha, Nebraska.
2 Division of Urology, University of Nebraska Medical Center , Omaha, Nebraska.
J Endourol. 2018 Oct;32(10):935-943. doi: 10.1089/end.2018.0394. Epub 2018 Aug 24.
To evaluate the safety and outcomes of robot-assisted radical prostatectomy (RARP) in renal transplant recipients (RTRs) based on available literature.
A literature search was performed using PubMed, Embase, and Web of Science through "robot" AND "prostatectomy" AND "transplant." Three authors separately reviewed the records to select the relevant articles with any discrepancies solved by open discussion. Patient age, prostate-specific antigen, Gleason score, and tumor stage were recorded as well as intraoperative and postoperative complications, length of stay, surgical margin status, and disease recurrence, if provided. The operative techniques and modification/adjustments to standard port placements were also reviewed. We also include our case report in this review.
We retrieved 10 articles reporting clinical data on RARP for kidney transplant patients, including 5 case series (level 4) and 5 case reports (level 4). A total of 35 kidney transplant recipients undergoing RARP were analyzed in this systematic review, one case in our institution included. None of the cases had major technical difficulties precluding the operation. Technical modifications to the standard technique were described in 10 of the 11 articles specifically including modifications to port placement (54% of patients), development of the space of Retzius (60% of patients), and performance of lymphadenectomy. Mean operative time was 220 minutes. Perioperative complication rate was 17.1% (6 of 35 patients), with only one Clavien III or greater complication. The rate of positive surgical margins was found to be 31.4%. Data on biochemical recurrence revealed a combined rate of 18.1%.
RARP is technically feasible for treating localized prostate cancer in RTRs. Graft function did not deteriorate in any patient. Modifications to the standard technique should be considered specifically for port placement, development of the space of Retzius, and performance of lymphadenectomy. Oncologic outcomes remain difficult to interpret given the small number of reported cases.
根据现有文献评估机器人辅助根治性前列腺切除术（RARP）在肾移植受者（RTR）中的安全性和结果。
通过“机器人”和“前列腺切除术”和“移植”在 PubMed、Embase 和 Web of Science 上进行文献检索。三位作者分别对记录进行审查，以选择具有任何差异的相关文章，并通过公开讨论解决差异。记录患者年龄、前列腺特异性抗原、Gleason 评分和肿瘤分期，以及术中术后并发症、住院时间、手术切缘状态和疾病复发情况（如有）。还审查了手术技术和对标准端口放置的修改/调整。我们还在本次综述中纳入了我们的病例报告。
我们检索到 10 篇报道肾移植患者接受 RARP 的临床数据的文章，包括 5 篇病例系列（4 级）和 5 篇病例报告（4 级）。本系统综述共分析了 35 例接受 RARP 的肾移植受者，其中包括我们机构的 1 例。没有任何病例存在阻止手术的主要技术困难。标准技术的技术修改在 11 篇文章中有具体描述，包括端口放置的修改（54%的患者）、Retzius 间隙的开发（60%的患者）和淋巴结切除术的实施。平均手术时间为 220 分钟。围手术期并发症发生率为 17.1%（35 例患者中有 6 例），仅有 1 例 Clavien III 级或更高级别的并发症。切缘阳性率为 31.4%。生化复发数据显示综合复发率为 18.1%。
RARP 技术上可用于治疗 RTR 中的局限性前列腺癌。没有患者的移植物功能恶化。应考虑对标准技术进行修改，特别是针对端口放置、Retzius 间隙的开发和淋巴结切除术的实施。鉴于报告病例数量较少，肿瘤学结果仍然难以解释。
