Department of Molecular Medicine, Surgery and Pelvic Cancer, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden.
Karolinska University Hospital, Eugeniavägen 3, 171 76, Solna, Sweden.
World J Urol. 2021 Sep;39(9):3239-3249. doi: 10.1007/s00345-021-03662-0. Epub 2021 Mar 20.
To evaluate urinary continence (UC) recovery and oncological outcomes in different risk-groups after robot-assisted radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP).
We analysed 2650 men with prostate cancer from seven open (n = 805) and seven robotic (n = 1845) Swedish centres between 2008 and 2011 in a prospective non-randomised trial, LAPPRO. UC recovery was defined as change of pads less than once in 24 h. Information was collected through validated questionnaires. Rate of positive surgical margins (PSM) and biochemical recurrence (BCR), defined as prostate-specific antigen (PSA) > 0.25 mg/ml, were recorded. We stratified patients into two risk groups (low-intermediate and high risk) based on the D'Amico risk classification system.
Among men with high-risk prostate cancer, we found significantly higher rates of UC recovery up to 24 months after RRP compared to RALP (66.1% vs 60.5%) RR 0.85 (CI 95% 0.73-0.99) while PSM was more frequent after RRP compared to RALP (46.8% vs 23.5%) RR 1.56 (CI 95% 1.10-2.21). In the same group no significant difference was seen in BCR. Overall, however, BCR was significantly more common after RRP compared to RALP at 24 months (9.8% vs 6.6%) RR 1.43 (Cl 95% 1.08-1.89). The limitations of this study are its non-randomized design and the relatively short time of follow-up.
Our study indicates that men with high-risk tumour operated with open surgery had better urinary continence recovery but with a higher risk of PSM than after robotic-assisted laparoscopic surgery. No significant difference was seen in biochemical recurrence. TRIAL REGISTRATION: ISRCTN06393679.
评估机器人辅助根治性前列腺切除术（RALP）和开放式经耻骨后根治性前列腺切除术（RRP）后不同风险组的尿控恢复和肿瘤学结果。
我们分析了 2008 年至 2011 年间来自瑞典七个开放（n=805）和七个机器人（n=1845）中心的 2650 名前列腺癌患者，这是一项前瞻性非随机试验 LAPPRO。尿控恢复定义为 24 小时内更换尿垫次数少于一次。通过验证问卷收集信息。记录阳性手术切缘（PSM）和生化复发（BCR）率，BCR 定义为前列腺特异性抗原（PSA）>0.25mg/ml。我们根据 D'Amico 风险分类系统将患者分为低-中危和高危两个风险组。
在患有高危前列腺癌的男性中，我们发现 RRP 术后 24 个月的尿控恢复率明显高于 RALP（66.1% vs 60.5%）RR 0.85（95%CI 0.73-0.99），而 RRP 术后 PSM 发生率高于 RALP（46.8% vs 23.5%）RR 1.56（95%CI 1.10-2.21）。在同一组中，RRP 和 RALP 在 BCR 方面没有显著差异。然而，总体而言，RRP 术后 24 个月时 BCR 发生率明显高于 RALP（9.8% vs 6.6%）RR 1.43（95%CI 1.08-1.89）。这项研究的局限性在于其非随机设计和相对较短的随访时间。
我们的研究表明，接受开放式手术治疗的高危肿瘤男性尿控恢复更好，但与机器人辅助腹腔镜手术相比，PSM 的风险更高。生化复发方面无显著差异。
ISRCTN06393679。
