Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland.
Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.
World J Urol. 2021 Feb;39(2):389-397. doi: 10.1007/s00345-020-03206-y. Epub 2020 Apr 23.
To evaluate the trends in risk-group distribution and Pentafecta outcomes in patients treated with nerve-sparing (NS), robot-assisted radical prostatectomy (RARP) in a single low-intermediate volume prostate cancer (PCa) center over a 10-year period.
We queried a prospectively maintained database for patients who underwent NS RARP between 2009 and 2018 in a low-intermediate volume PCa center. Risk-groups were defined according to the D'Amico classification. Pentafecta outcomes referred to the postsurgical presence of potency and continence, and the absence of biochemical recurrence (BCR), positive surgical margins (PSM), and perioperative complications. The Kruskall-Wallis test, the t test and the Mann-Whitney tests were used when appropriate.
603 patients underwent NS RARP and 484 patients were evaluated for Pentafecta outcomes. Median postsurgical follow-up was 28 months. Overall, 137 (22.7%), 376 (62.3%), and 90 (15%) patients were diagnosed in the low-, intermediate-, and high-risk groups, respectively. Patients undergoing NS RARP shifted from 33 to 20% in the low-risk group, from 52 to 62% in the intermediate-risk group, and from 10 to 13% in the high-risk group. Patients reaching Pentafecta increased from 38 to 44%. No postoperative potency was the main reason for non-achieving Pentafecta (71%). BCR strongly limited Pentafecta achievement in the high-risk group (61%), but not in intermediate (24%) and low-risk (30%) groups.
Low-intermediate volume PCa centers show similar trends to high-volume centers regarding risk group distributions over time in PCa patients undergoing NS RARP. We reported an increase in Pentafecta outcomes achievement over time even for experienced surgeons. Pentafecta outcomes achievement is risk-group dependent.
在一个低容量前列腺癌（PCa）中心，评估 10 年间接受神经保留（NS）机器人辅助根治性前列腺切除术（RARP）治疗的患者的风险组分布和 Pentafecta 结果的趋势。
我们在一个低容量 PCa 中心查询了 2009 年至 2018 年间接受 NS RARP 的患者的前瞻性数据库。风险组根据 D'Amico 分类定义。Pentafecta 结果指手术后存在勃起功能和尿控，并且没有生化复发（BCR）、阳性手术切缘（PSM）和围手术期并发症。适当的时候使用 Kruskal-Wallis 检验、t 检验和 Mann-Whitney 检验。
603 例患者接受 NS RARP，484 例患者评估 Pentafecta 结果。中位术后随访时间为 28 个月。总体而言，137（22.7%）、376（62.3%）和 90（15%）例患者分别诊断为低危、中危和高危组。接受 NS RARP 的患者在低危组从 33%降至 20%，在中危组从 52%增至 62%，在高危组从 10%降至 13%。达到 Pentafecta 的患者从 38%增加到 44%。无法获得术后勃起功能是无法达到 Pentafecta 的主要原因（71%）。BCR 强烈限制了高危组（61%）的 Pentafecta 获得，但在中危组（24%）和低危组（30%）中则不然。
低容量 PCa 中心在接受 NS RARP 治疗的 PCa 患者中，随着时间的推移，风险组分布与高容量中心类似。我们报告说，即使是经验丰富的外科医生，Pentafecta 结果的获得也在随着时间的推移而增加。Pentafecta 结果的获得与风险组有关。
