Unit of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
Unit of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Minerva Urol Nephrol. 2022 Oct;74(5):607-614. doi: 10.23736/S2724-6051.22.04857-1. Epub 2022 Jun 16.
The study aim was to report the results of Retzius-Sparing robot-assisted radical Prostatectomy (RSP) in high-risk prostate cancer (HR-PCa) patients in a multicentric setting of expert surgeons and to analyze predictors of positive surgical margins (PSMs) and urinary continence recovery.
We retrospectively evaluated all consecutive HR-PCa patients who underwent RSP by expert surgeons in 7 centers. Pre-, peri- and postoperative features were collected. Minimum surgical experience required was 100 RSP cases. The oncological outcomes evaluated were PSMs and biochemical relapse (BCR). Urinary continence was defined as no pad or safety pad. Erectile function was defined as erections sufficient for intercourse.
We collected 579 patients operated by 9 surgeons. Median age was 66, median PSA was 9,6 ng/mL. ISUP biopsy was 1 in 3.8%, 2 in 23%, 3 in 32,6%, 4 in 19,9%, 5 in 20,7; median surgical time was 195 minutes. Pathological stage was pT2 in 40,1%, pT3a in 35,9%, pT3b in 23,1%, and pT4 in 0,9% of cases. PSMs were present in 31,3% of cases. Urinary continence was achieved in 66,8% of cases one week after catheter removal. At 22 months (median follow-up), 89,1% patients were continent, BCR occurred in 27,5% patients. In multivariate analysis, PSA, prostate volume, surgical time were independent predictors of PSMs; ASA score and PSMs predicted urinary continence.
We report the first multicentric experience of RSP for HR-PCa. Considering HR cases as those with the worst functional results, 89% of continent patients confirms that RSP helps achieve good functional results.
本研究旨在报告在专家外科医生的多中心环境中，保Retzius 间隙的机器人辅助根治性前列腺切除术（RSP）治疗高危前列腺癌（HR-PCa）患者的结果，并分析切缘阳性（PSM）和尿控恢复的预测因素。
我们回顾性评估了 7 家中心的专家外科医生为 HR-PCa 患者进行的所有连续 RSP。收集了术前、术中和术后的特征。最低手术经验要求为 100 例 RSP 病例。评估的肿瘤学结果是 PSM 和生化复发（BCR）。尿控定义为无需使用尿垫或安全垫。勃起功能定义为足以进行性交的勃起。
我们共收集了 579 例由 9 名外科医生进行的手术。中位年龄为 66 岁，中位 PSA 为 9.6ng/mL。ISUP 活检为 1 级的占 3.8%，2 级的占 23%，3 级的占 32.6%，4 级的占 19.9%，5 级的占 20.7%；中位手术时间为 195 分钟。病理分期为 pT2 占 40.1%，pT3a 占 35.9%，pT3b 占 23.1%，pT4 占 0.9%。31.3%的病例存在 PSM。拔除导尿管后一周，66.8%的患者实现尿控。中位随访 22 个月时，89.1%的患者无尿失禁，27.5%的患者发生 BCR。多变量分析显示，PSA、前列腺体积和手术时间是 PSM 的独立预测因素；ASA 评分和 PSM 预测尿控。
我们报告了首例高危前列腺癌保Retzius 间隙的机器人辅助根治性前列腺切除术的多中心经验。考虑到 HR 病例的功能结果最差，89%的尿控患者证实 RSP 有助于获得良好的功能结果。
