是否該改用Retzius保留式機械手臂攝護腺根除手術治療攝護腺癌症？
林嘉彥、楊晨洸、歐宴泉
臺中榮民總醫院 外科部 泌尿外科
Should we shift to retzius-preserving robotic assisted laparoscopic radical prostatectomy?
Chia-yen Lin, Yen-chuan Ou, Cheng-kuang Yang
Division of Urology, Department of Surgery, Taichung Veterans General Hospital
Purpose: Some studies reported an comparable oncological outcome and better early continence rate of Retzius-preserving robotic assisted laparoscopic radical prostatectomy (RALP). We want to compare the early perioperative and continence outcome. And we are also eager to know if the learning curve of Retzius-preserving surgery would compromise the outcome or not?
Materials and Methods: We selected patient with organ-confined prostate cancer (≤ cT2c), PSA ≤ 40, Gleason score of biopsy ≤ 8, prostate volume ≤ 50 ml and BMI < 35. We plan to collect consecutive 50 cases from Febuary, 2015. We design a case control matching study with 25 cases of each Retzius-preserving RALP and conventional RALP group. Postoperative parameter and early continence result was compared. This is our early result of original study design.
Results: From Febuary 1, 2015 to March 17, 2015, a total consecutive 21 cases of RALP were evaluated. Eight of them underwent Retzius-preserving RALP. There is no statistical difference of preoperative characteristics. There were no significant differences in mean length of hospital stay, intra- and postoperative complication rates, pathological stage of disease, Gleason scores, tumour volumes and positive surgical margins between the conventional RALP and Retzius-sparing RALP groups. However, console time, Vesicourethral anastomosis time and estimated blood loss Console time were longer for Retzius-sparing RALP. There is no significant difference of early continence at 4 weeks between.
Conclusion: Based on the early result of this study, Retzius-preserving RALP is a feasible and safe treatment choice for localized prostate cancer. Both console time and estimated blood loss are favoring to conventional RALP. Further study and accumulation of experience are needed for final conclusion..