Abdel Raheem Ali, Hagras Ayman, Ghaith Ahmed, Alenzi Mohamed J, Elghiaty Ahmed, Gameel Tarek, Alowidah Ibrahim, Ham Won S, Choi Young D, El-Bahnasy Abdel H, Omar Adel, El-Bendary Mohamed, Rha Koon H
Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia.
Minerva Urol Nefrol. 2020 Oct;72(5):586-594. doi: 10.23736/S0393-2249.20.03830-8. Epub 2020 Aug 4.
The aim of the present study was to compare the surgical outcomes of retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and open retropubic radical prostatectomy (ORP).
We included patients with clinically localized prostate cancer who underwent RS-RARP or ORP and met our inclusion criteria. We compared the perioperative, oncological, and continence outcomes between both surgical approaches. Continence function was assessed using the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Continence was defined as using 0-1 safety pad per day. Biochemical recurrence (BCR) was defined as two consecutive rises in serum PSA more than 0.2 ng/mL. Events of local recurrence, distant metastasis, and cancer death were reported and compared using Kaplan-Meier survival analysis.
Between 1 June 2013 and 1 October 1 2016, 184 men were enrolled, of whom 125 underwent RS-RARP and 59 underwent ORP. Baseline demographic and pathological characteristics were similar between both groups (P>0.05). Patients in RS-RARP group had significantly lower blood loss, fewer transfusion rates, lower VAS score, and shorter hospital stay than patients in ORP group (P<0.05). Major complications (≥grade 3b) did not differ between both groups (P=0.121). Positive surgical margins were 28.8% and 24.8% in ORP and RS-RARP, respectively (P=0.494). The BCR free-survival rates in ORP and RS-RARP at 1-year was 87.3% and 92.3%, respectively (Log-rank, P=0.740). At 1-, 6-, and 12-month after surgery, 42.4%, 79.7%, and 84.7% of men undergoing ORP were continent, compared with 72.8%, 90.4%, and 92% undergoing RS-RARP, respectively. Men in RS-RARP group achieved faster recovery of urinary continence compared to men in ORP group (Log-rank, P=0.001).
RS-RARP had better perioperative outcomes and faster recovery of urinary continence compared with ORP. Short-term oncological outcomes were comparable between both surgical approaches.
本研究旨在比较保留耻骨后间隙机器人辅助根治性前列腺切除术（RS-RARP）与开放性耻骨后根治性前列腺切除术（ORP）的手术效果。
我们纳入了接受RS-RARP或ORP且符合纳入标准的临床局限性前列腺癌患者。我们比较了两种手术方式的围手术期、肿瘤学及控尿效果。使用经过验证的《国际尿失禁咨询问卷-尿失禁简表》评估控尿功能。控尿定义为每天使用0-1个安全护垫。生化复发（BCR）定义为血清PSA连续两次升高超过0.2 ng/mL。报告局部复发、远处转移及癌症死亡事件，并使用Kaplan-Meier生存分析进行比较。
在2013年6月1日至2016年10月1日期间，共纳入184名男性，其中125例行RS-RARP，59例行ORP。两组间基线人口统计学和病理特征相似（P>0.05）。RS-RARP组患者的失血量显著低于ORP组，输血率更低，视觉模拟评分（VAS）更低，住院时间更短（P<0.05）。两组间严重并发症（≥3b级）无差异（P=0.121）。ORP和RS-RARP的手术切缘阳性率分别为28.8%和24.8%（P=0.494）。ORP和RS-RARP在1年时的无生化复发生存率分别为87.3%和92.3%（对数秩检验，P=0.740）。术后1个月、6个月和12个月时，接受ORP的男性控尿率分别为42.4%、79.7%和84.7%，而接受RS-RARP的男性控尿率分别为72.8%、90.4%和92%。与ORP组男性相比，RS-RARP组男性尿失禁恢复更快（对数秩检验，P=0.001）。
与ORP相比，RS-RARP具有更好的围手术期效果和更快的尿失禁恢复。两种手术方式的短期肿瘤学效果相当。
