Bejrananda Tanan, Karnjanawanichkul Watid, Tanthanuch Monthira
Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
Minim Invasive Surg. 2023 Feb 7;2023:3263286. doi: 10.1155/2023/3263286. eCollection 2023.
This study aimed to compare the oncological, functional, and perioperative outcomes of localized and locally advanced prostate cancer treated with intraperitoneal or extraperitoneal laparoscopic radical prostatectomy (LRP).
From April, 2008, through December, 2020, 266 patients underwent laparoscopic radical prostatectomy, 168 cases with an extraperitoneal approach (E-LRP) and 98 cases using a transperitoneal approach (T-LRP). The clinical, perioperative, functional, and oncological outcomes were collected and compared between these groups. At the 3-, 12- and 24-monthfollow-ups, the functional outcomes tested were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC). The oncological outcomes of biochemical recurrence, biochemical recurrence-free survival, and positive surgical margin status were evaluated. Univariable and multivariable Cox regression analyses were used to identify factors predictive for biochemical recurrence. All statistical analyses used the R program.
The patient characteristics were similar between the E-LRP and T-LRP groups except for higher prostatic-specific antigen (PSA) in the T-LRP group. The T-LRP had lower overall operative time (222.5 min vs. 290 min, 0.001), decreased blood loss (400 ml vs. 800 ml, < 0.001), and shorter hospital stays (4 days vs. 7 days, < 0.001) compared to the E-LRP. Early sexual intercourse with penetration at 3 months was higher in the T-LRP group (36.7% vs. 15.5%, 0.001). Urinary continence (no pads) was not different between the T-LRP and E-LRP groups at 3 and 24 months after surgery but higher in the E-LRP group at 12 months (1% vs. 3%; =0.419, 85.1 vs. 83.7%; =0.889, 47.4% vs. 34.6%; =0.028, respectively). The EPIC questionnaire was used to assess functional outcomes at 3, 12, and 24 months after surgery and found that urinary function was significantly higher in the T-LRP group at 3 and 12 months ( < 0.001) but did not show a difference at 24 months (=0.734), and sexual function scores were higher in the T-LRP group at 12 and 24 months (=0.001). The positive surgical margin rate was higher in the E-LRP (38.7% vs. 21.4%; =0.006). The BCR rate was not different between the groups (36.3% in the E-LRP group and 27.6% in the E-LRP group; =0.184).
Transperitoneal laparoscopic radical prostatectomy (T-LRP) was found to be superior to extraperitoneal radical prostatectomy (E-LRP) in perioperative outcomes such as decreased operative time, decreased blood loss, shorter hospital stay, lower positive surgical margin, and improved early sexual intercourse and sexual function. The urinary functional outcome was better in the T-LRP group at 3 and 12 months. These findings support the use of transperitoneal laparoscopic radical prostatectomy, as our study patients exhibited significant benefits from this procedure.
本研究旨在比较经腹腔或腹膜外腹腔镜根治性前列腺切除术（LRP）治疗局限性和局部进展性前列腺癌的肿瘤学、功能和围手术期结局。
从2008年4月至2020年12月，266例患者接受了腹腔镜根治性前列腺切除术，168例采用腹膜外入路（E-LRP），98例采用经腹腔入路（T-LRP）。收集并比较两组的临床、围手术期、功能和肿瘤学结局。在3个月、12个月和24个月的随访中，测试的功能结局包括尿功能（EPIC尿功能领域）和性功能（EPIC性功能领域）。评估生化复发、无生化复发生存和手术切缘阳性状态的肿瘤学结局。采用单变量和多变量Cox回归分析来确定预测生化复发的因素。所有统计分析均使用R程序。
除T-LRP组前列腺特异性抗原（PSA）较高外，E-LRP组和T-LRP组患者特征相似。与E-LRP相比，T-LRP的总手术时间较短（222.5分钟对290分钟，P<0.001），失血量减少（400毫升对800毫升，P<0.001），住院时间缩短（4天对7天，P<0.001）。T-LRP组3个月时能进行插入式早期性交的比例更高（36.7%对15.5%，P<0.001）。术后3个月和24个月时，T-LRP组和E-LRP组的尿控（无需使用尿垫）情况无差异，但术后12个月时E-LRP组更高（1%对3%，P=0.419；85.1%对83.7%，P=0.889；47.4%对34.6%，P=0.028）。使用EPIC问卷评估术后3个月、12个月和24个月的功能结局，发现T-LRP组在术后3个月和12个月时尿功能显著更高（P<0.001），但在24个月时无差异（P=0.734），且T-LRP组在术后12个月和24个月时性功能评分更高（P=0.001）。E-LRP组的手术切缘阳性率更高（38.7%对21.4%，P=0.006）。两组间的生化复发率无差异（E-LRP组为36.3%，T-LRP组为27.6%，P=0.184）。
发现经腹腔腹腔镜根治性前列腺切除术（T-LRP）在围手术期结局方面优于腹膜外根治性前列腺切除术（E-LRP），如手术时间缩短、失血量减少、住院时间缩短、手术切缘阳性率降低以及早期性交和性功能改善。T-LRP组在术后3个月和12个月时尿功能结局更好。这些发现支持使用经腹腔腹腔镜根治性前列腺切除术，因为我们研究中的患者从该手术中获得了显著益处。
