Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, 06106, USA.
Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA.
World J Urol. 2023 Apr;41(4):1047-1053. doi: 10.1007/s00345-023-04346-7. Epub 2023 Mar 17.
To evaluate a single surgeon's 20-year experience with robotic radical prostatectomy.
Patients who had undergone robot-assisted laparoscopic prostatectomy by a single surgeon were identified via an IRB approved prospectively maintained prostate cancer database. Patients were divided into 5-year cohorts (cohort A 2001-2005; cohort B 2006-2010; cohort C 2011-2015; cohort D 2016-2021) for analysis. Oncologic and quality of life outcomes were recorded at the time of follow-up visits. Continence was defined as 0-1 pad with occasional dribbling. Potency was defined as intercourse or an erection sufficient for intercourse within the last 4 weeks.
Three thousand one hundred fifty-two patients met criteria for inclusion. Clavien ≥ 3 complication rates decreased from 5.9% to 3.2%, p = 0.021. There was considerable Gleason grade group (GG) and stage migration to more advanced disease between cohort A (6.4% GG4 or GG5, 16.2% pT3 or pT4, 1.2% N1) and cohort D (17% GG4 or GG5, 45.5% pT3 or pT4, 14.4% N1; p < 0.001). Consistent with this, an increasing proportion of patients required salvage treatments over time (14.6% of cohort A vs 22.5% of cohort D, p < 0.001). 1-year continence rates improved from 74.8% to greater than 92.4%, p < 0.001. While baseline potency and use of intraoperative nerve spare decreased, for patients potent at baseline, there were no significant differences for potency at one year (p = 0.065).
In this 20-year review of our experience with robotic prostatectomy, complication rates and continence outcomes improved over time, and there was a migration to more advanced disease at the time of surgery.
评估一位外科医生 20 年的机器人根治性前列腺切除术经验。
通过经机构审查委员会批准的前瞻性维护的前列腺癌数据库，确定接受单一外科医生机器人辅助腹腔镜前列腺切除术的患者。患者被分为 5 年队列（队列 A：2001-2005 年；队列 B：2006-2010 年；队列 C：2011-2015 年；队列 D：2016-2021 年）进行分析。在随访时记录肿瘤学和生活质量结果。控尿定义为 0-1 片尿垫，偶尔有滴漏。勃起功能定义为过去 4 周内进行性交或勃起足以进行性交。
符合纳入标准的患者有 3152 名。Clavien≥3 级并发症发生率从 5.9%降至 3.2%，p=0.021。在 A 队列（6.4% GG4 或 GG5，16.2% pT3 或 pT4，1.2% N1）和 D 队列（17% GG4 或 GG5，45.5% pT3 或 pT4，14.4% N1；p<0.001）之间，格里森分级组（GG）和疾病分期存在明显的迁移，向更晚期疾病发展。与此一致的是，随着时间的推移，需要挽救性治疗的患者比例也在增加（A 队列的 14.6%与 D 队列的 22.5%，p<0.001）。1 年控尿率从 74.8%提高到 92.4%以上，p<0.001。虽然基线勃起功能和术中神经保留的使用减少，但对于基线有勃起功能的患者，1 年时勃起功能无显著差异（p=0.065）。
在这项对我们机器人前列腺切除术经验进行的 20 年回顾中，随着时间的推移，并发症发生率和控尿效果得到改善，而手术时的疾病分期也向更晚期迁移。
