经单孔或多孔机器人平台微创细胞减灭性根治性前列腺切除术，探索其安全性和可行性。
Minimally invasive cytoreductive radical prostatectomy, exploring the safety and feasibility of a single-port or multi-port robotic platform.
机构信息
Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, CA, USA.
出版信息
BMC Urol. 2024 Mar 26;24(1):72. doi: 10.1186/s12894-024-01463-2.
BACKGROUND
Consolidative resection or cytoreductive radical prostatectomy (CRP) may benefit men with non-organ confined prostate cancer. We report the safety, feasibility, and outcomes of robot-assisted laparoscopic CRP using a single-port (SP) or multi-port (MP) platform.
METHODS
We reviewed consecutive men with clinical node positive or metastatic castrate-sensitive prostate cancer who underwent IRB-approved CRP and extended pelvic lymph node dissection using the da Vinci SP or MP Surgical Systems (Intuitive Surgical, Sunnyvale, CA) from 2015-2022. Perioperative data and Clavien-Dindo 90-day complications were recorded.
RESULTS
Twenty-four men with a median age of 61 (IQR 56-69) years and prostate-specific antigen of 32.1 (IQR 21.9-62.3) ng/mL were included. Clinical N1, M1, or N1 + M1 disease were detected in 8 (33%), 9 (38%), 7 (29%) patients, respectively. There was no difference in positive margins, 41% vs. 29% (P = 0.67), lymph node yield, 21 (IQR 14-28) vs. 20 (IQR 13.5-21) nodes (P = 0.31), or estimated blood loss, 150 mL (IQR 100-200) vs. 50 mL (IQR 50-125) (P = 0.06), between the MP and SP cohorts, respectively. Hospital length of stay was significantly shorter for the SP group, same-day discharge (IQR 0-0), compared to MP, 1-day (IQR 1-1), P < 0.001. One grade III bowel obstruction and lymphocele occurred in the MP cohort. No major complications occurred in the SP cohort.
CONCLUSION
Robot-assisted laparoscopic CRP is safe and feasible for select men with advanced castrate-sensitive prostate cancer.
背景
巩固性切除术或细胞减灭性根治性前列腺切除术（CRP）可能有益于非器官受限的前列腺癌患者。我们报告了使用达芬奇单端口（SP）或多端口（MP）平台进行机器人辅助腹腔镜 CRP 的安全性、可行性和结果。
方法
我们回顾了 2015 年至 2022 年间，连续接受 IRB 批准的 CRP 和扩展盆腔淋巴结清扫术的临床淋巴结阳性或转移性去势敏感前列腺癌男性患者的资料，这些患者使用了 da Vinci SP 或 MP 手术系统（Intuitive Surgical，加利福尼亚州森尼韦尔）。记录围手术期数据和 Clavien-Dindo 90 天并发症。
结果
24 名男性患者的中位年龄为 61 岁（IQR 56-69 岁），前列腺特异性抗原为 32.1（IQR 21.9-62.3）ng/ml。分别有 8（33%）、9（38%）、7（29%）例患者存在临床 N1、M1 或 N1+M1 疾病。阳性切缘、41%与 29%（P=0.67）、淋巴结产量、21（IQR 14-28）与 20（IQR 13.5-21）个（P=0.31）或估计失血量、150ml（IQR 100-200）与 50ml（IQR 50-125）（P=0.06）在 MP 和 SP 队列之间无差异。SP 组的住院时间明显短于 MP 组，当天出院（IQR 0-0），而 MP 组为 1 天（IQR 1-1），P<0.001。MP 组发生 1 例 III 级肠梗阻和淋巴囊肿。SP 组无重大并发症发生。
结论
机器人辅助腹腔镜 CRP 对选择的晚期去势敏感前列腺癌男性患者是安全可行的。
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