局部侵犯型攝護腺癌於達文西機器人輔助手術後的手術標本邊緣陽性:學習曲線分析與相關文獻探討

何肇晏^1,3、林宜佳^1,2、蔡德甫^1,2、葉忠信^1,2、莊光達^1,2、鄭以弘¹、仇光宇^1,2、陳宏恩¹、吳子翔¹、葉志胤¹、朱懿柏¹、歐詠豪¹、黃一勝^1,2

1.     新光吳火獅紀念醫院 外科部 泌尿科；2.輔仁大學; 3.陽明大學

Positive Surgical Margin of Locally advanced Prostate Cancer: Learning Curve and Literature Review

Chao-Yen Ho^1,3, Yi-Chia Lin^1,2, Te-Fu Tsai^1,2, Ao Weng-Hou¹, Chung-Hsin Yeh^1,2, Guang-Dar Juang^1,2, Yi-Hong Cheng¹, Kuang-Yu Chuo^1,2, Hung-En Chen¹, Tzu-Hsiang Wu¹, Chih-Yin Yeh¹, Yi-Bo Chu¹, Thomas I.S. Hwang^1,2

1.Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital, Taipei, Taiwan

2.Fu-Jen Catholic university, New Taipei, Taiwan

3. National Yang Ming University, Taipei, Taiwan

Purpose: The presence of positive surgical margins (PSM) following robotic-assisted radical prostatectomy (RARP) is high in locally advanced prostate cancer patients. In Our early experience also revealed a very high PSM rates in these patients. Our goal was to assess the incidence of positive surgical margins in our series of RARP and its relationship to our learning curve. Relative literatures in this issue were also reviewed and discussed.

Materials and Methods: From June 2014 to March 2019, a total 93 patients underwent robotic-assisted radical prostatectomy in Shin Kong WHS Memorial Hospital. A total 47 patients with pathologic T3a and T3b disease was enrolled. The initial 30 patients with locally advanced prostate cancer and the 17 patients after were separated in to Group A and Group B, correspondingly. Further positive surgical margin rate was analyzed.

Results: There was significant difference in the positive surgical margin rate (PSM) between two groups. The PSM rate of Group A and Group B was 90% and 58.8% (p<0.05). The overall PSM rate in T3a disease was 71%, and was 93.7% in T3b disease. Group B patient was T3a disease had a lowest PSM rate as 30%.

Conclusions: In SKH experience, a learning curve of 30 patients with locally advanced prostate cancer was warranted to reach a PSM rate less than 60% in T3 disease. The best improvement was in T3a disease, the PSM rate before and after learning curve was 70.4% and 30%. It emphasized the importance of surgeon experience on surgical outcome. It may need a longer learning curve in real world to overcome the high PSM rate in T3b disease.