Division of Urology, Department of Surgery, Section of Urology, Augusta University, 1120 15th Street, BA-8414, Augusta, GA, 30912-4050, USA.
Medical College of Georgia, Augusta, USA.
J Robot Surg. 2021 Apr;15(2):221-228. doi: 10.1007/s11701-020-01096-1. Epub 2020 May 29.
Our objective is to report the functional and oncologic outcomes of a cohort of 250 consecutive prostate cancer patients undergoing a Retzius-sparing approach and to assess for racial differences in continence outcomes. This was a prospective, single-center, case series of 250 consecutive prostate cancer patients who underwent a Retzius-sparing robotic-assisted laparoscopic radical prostatectomy by a single surgeon between May 2015 and April 2019. Our primary objective was to report post-operative continence outcomes of patients undergoing this technique. Continence was defined as using zero or one precautionary pad per day. Median follow-up was 24.0 months [interquartile range (IQR) 18.0-30.0 months]. Median age and body mass index were 62.0 years (IQR 57.0-67.0) and 29.0 kg/m (IQR 26.0-33.0), respectively. Median PSA was 8.22 ng/ml (IQR 5.74-13.31). 84.8% of patients were intermediate risk or high risk pre-operatively, as per AUA/ASTRO/SUO guidelines. 96.0% had Gleason Score 7 or worse disease on final pathologic analysis. Positive margin incidence was 18.1% and 44.4% in patients with pT2 and pT3 disease, respectively, of which 75.4% were unifocal. Immediate continence (i.e., continence achieved within 1 month post-operatively) was achieved in 45.2% of patients. Three-month and 1-year continence rates were 70.0% and 92.0%, respectively. Caucasian patients experienced earlier return of continence (77% versus 65% at 3 months) compared to African American patients. IPSS scores gradually improved from 8.0 pre-operatively to 4.0 1-year later. Median PSA level was 0.01 ng/ml (IQR 0.01-9.01) post-operatively. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy is an oncologically safe surgical technique with excellent short- and long-term continence outcomes. Caucasian patients may have earlier return of continence compared to African Americans.
我们的目的是报告 250 例连续前列腺癌患者接受保留耻骨后间隙入路的功能和肿瘤学结果，并评估种族间控尿结果的差异。这是一项前瞻性、单中心、病例系列研究，共纳入 250 例连续前列腺癌患者，均由一位外科医生于 2015 年 5 月至 2019 年 4 月期间行保留耻骨后间隙的机器人辅助腹腔镜根治性前列腺切除术。我们的主要目的是报告采用该技术的患者术后控尿结果。控尿定义为每天使用零或一片预防性尿垫。中位随访时间为 24.0 个月（IQR 18.0-30.0 个月）。中位年龄和体重指数分别为 62.0 岁（IQR 57.0-67.0）和 29.0kg/m（IQR 26.0-33.0）。中位 PSA 为 8.22ng/ml（IQR 5.74-13.31）。84.8%的患者根据 AUA/ASTRO/SUO 指南术前为中危或高危。96.0%的患者最终病理分析为 Gleason 评分 7 或更差。pT2 和 pT3 疾病患者的阳性切缘发生率分别为 18.1%和 44.4%，其中 75.4%为单灶性。45.2%的患者术后 1 个月内实现即刻控尿（即术后 1 个月内获得控尿）。3 个月和 1 年的控尿率分别为 70.0%和 92.0%。与非裔美国人相比，白人患者更早恢复控尿（3 个月时为 77%，65%）。IPSS 评分从术前的 8.0 逐渐改善到术后 1 年的 4.0。术后中位 PSA 水平为 0.01ng/ml（IQR 0.01-9.01）。保留耻骨后间隙的机器人辅助腹腔镜根治性前列腺切除术是一种具有良好短期和长期控尿效果的肿瘤学安全手术技术。与非裔美国人相比，白人患者可能更早恢复控尿。
