Retzius-Sparing 機器人輔助根治性攝護腺切除術和擴大盆腔淋巴結清除術對

非常高風險攝護腺癌的治療效果

林威宇、邱國雄 、劉昱良、黃國財、林建煇、何東儒、黃雲慶、陳志碩、楊紫馨、王姿惠

嘉義長庚紀念醫院 外科部泌尿科

Retzius-Sparing Robot-assisted Radical Prostatectomy and

Extended Pelvic Lymph Node Dissection for Very High-Risk Prostate Cancer

Wei-Yu Lin, Kuo Hsiung-Chiu, Yu-Liang,Liu, Kuo-Tsai Huang, Jian-Hui Lin, Dong-Ru Ho, Yun-Ching Huang, Chih-Shou Chen, Tzu-Hsin Yang, Tzu-Hui Wang

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

Purpose: Limited data are available on the role of retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and extend pelvic lymph node dissection (ePLND) in patients with very high risk prostate cancer (VHPCa). We aimed to assess the oncological and functional outcomes of RS- RALP and ePLND

for VHPCa patients

Materials and Methods : 50 patients who underwent RS-RARP and ePLND between 2019 and 2022, 16 VHPCa patients (32%) and 34 non-VHPCa patients (68%) were retrospectively evaluated. Perioperative,

functional, and oncological outcomes were compared between groups.

Results: Perioperative outcomes including operative time and estimated blood loss were comparable. Overall, 14 (28%), 11 (22%), and 13 (24%) patients had pT3b, pN1, and positive surgical margins (PSM). VHPCa revealed higher LN involvements and PSM. The median number of nodes removed in ePLND was 18. Discrepancy between clinical and pathological nodal status was more frequent in VHPCa. Overall, 6 (12%) patients experienced complications and 5 (10%) and 1 (2 %) patients had Clavien III and IV complications. Only 1 (2 %) VHPCa patients had Clavien III complications. Overall, 3 (6%) and 14 (28%) patients received adjuvant radiotherapy and hormonal therapy, whose majority was among the VHPCa. The median follow-up was 12 mo. Biochemical recurrence (BCR) was defined as two consecutive prostate-specific antigen values 0.1 ng/ml. Overall, BCR-free survival were 97%, including 20% of patients on adjuvant or salvage ADT, who were all among VHPCa. 3 months after surgery, 90% men used no pad or one safety pad. However, 10% men, who were all VHPCa, used more than one safety pads

Conclusions: RS- RALP and ePLND is a feasible option for VHPCa patients, although the functional outcomes were not as favorable. The improved oncological outcomes could be owing to its potential

curative role and the correct staging for subsequent multimodal treatments.