Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Surgery, Division of Urology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
J Endourol. 2021 Jul;35(7):1013-1019. doi: 10.1089/end.2020.0770. Epub 2021 Feb 23.
To present multinational experience in robot-assisted radical prostatectomy (RARP) by fellowship-trained expertise in low-volume regions in Gulf Cooperation Council (GCC) countries and to compare the current results with global outcomes reported in recent meta-analyses. A retrospective review of prospectively collected data was performed for patients undergoing RARP for localized prostate cancer (PCa). Three fellowship-trained surgeons at four academic and referral centers in Saudi Arabia and Kuwait performed all procedures between February 2014 and December 2019. Data on demographics, perioperative characteristics, pathology, and adverse events were collected. A total of 207 patients were included with a median (IQR) follow-up duration of 28 (15-38) months. The median prostate volume and prostate-specific antigen were 42 (32-53) g and 9.1 (5.8-14.1) ng/mL, respectively. While 65.2% of patients had a Gleason score ≥7, 20% had grade group 4 disease, and 7.8% had ≥cT3 disease. The mean ± SD operative time was 203 ± 52 minutes, and the mean estimated blood loss was 158 ± 107 mL. Only 4 (1.9%) patients received perioperative blood transfusions. Positive surgical margins were observed in 21.7% of patients, all of whom had ≥pT3 disease. There were 23 complications in 18 (8.7%) patients, including Clavien-Dindo grade III complications in 2.4%. At the 12-month follow-up, 35.8% of patients were potent, 94.6% were continent, and 9.2% had biochemical recurrence. The safety and efficacy of RARP by fellowship-trained expertise in GCC countries were well established. The outcomes seem promising and comparable to international centers and should improve with increasing case volume and fellowship-trained expertise.
介绍在海湾合作委员会（GCC）国家低容量地区接受 fellowship 培训的专业人员进行机器人辅助根治性前列腺切除术（RARP）的多国经验，并将当前结果与最近荟萃分析中全球报告的结果进行比较。对在沙特阿拉伯和科威特的 4 个学术和转诊中心接受 RARP 治疗局限性前列腺癌（PCa）的患者进行了前瞻性收集数据的回顾性分析。三位 fellowship 培训的外科医生在 2014 年 2 月至 2019 年 12 月期间进行了所有手术。收集了人口统计学，围手术期特征，病理学和不良事件的数据。共纳入 207 例患者，中位（IQR）随访时间为 28（15-38）个月。前列腺体积和前列腺特异性抗原的中位数分别为 42（32-53）g 和 9.1（5.8-14.1）ng/ml。65.2％的患者 Gleason 评分≥7，20％的患者分级组 4 级疾病，7.8％的患者≥cT3 级疾病。平均手术时间±SD 为 203±52 分钟，平均估计出血量为 158±107ml。仅 4（1.9％）例患者接受围手术期输血。21.7％的患者有阳性切缘，所有患者均有≥pT3 级疾病。18 例（8.7％）患者中有 23 例并发症，包括 2.4％的 Clavien-Dindo Ⅲ级并发症。在 12 个月的随访中，35.8％的患者有能力，94.6％的患者有节制，9.2％的患者有生化复发。在 GCC 国家，由 fellowship 培训的专业人员进行的 RARP 的安全性和有效性已得到充分证实。结果似乎很有希望，与国际中心相当，并且随着病例量的增加和 fellowship 培训的专业知识的提高，结果应该会得到改善。
