機器手臂攝護腺根除手術後切緣陽性與攝護腺癌復發之探討
吳勝堂、高建璋、曹智惟、唐守宏、蒙恩、孫光煥、于大雄、范保羅、陳宏一、張聖原、查岱龍
國防醫學院 三軍總醫院 外科部 泌尿外科
Impact of positive surgical margin on prostate cancer recurrence after robot-assisted laparoscopic radical prostatectomy
Sheng-Tang Wu, Chien-Chang Kao, Chu-Wei Tsao, Shou-Hung Tang, En Meng, Guang-Huan Sun, Dah-Shyong Yu, Pao-Luo Fan, Hong-I Chen, Sun-Yran Chang, Tai-Lung Cha
Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Purpose:
We analyzed the impact of positive surgical margins on prostate specific antigen (PSA) recurrence in patients after robot-assisted laparoscopic radical prostatectomy (RARP) as definitive local treatment for prostate cancer
Materials and Methods:
There were 294 consecutive patients who underwent RARP for prostate cancer between Jan 2008 and Aug 2013. Patients without undetectable PSA within 3 months after RARP, or with postoperative adjuvant radiotherapy due to adverse pathological features that suggested by NCCN guideline were excluded. We retrospectively analyzed the records of 219 patients. Demographic features, initial and followed PSA, Gleason score, and pathologic stage of prostate were reviewed.
Results:
A total of 20 patients (9.1%) developed biochemical recurrence. Forty-one patients (18.7%) with positive surgical margins (PSM+). In all patients (n=219), with biochemical recurrence (BCR+, n=20), and no BCR (BCR-, n=199) patients group, the mean age was 64.6, 61.9, and 64.9 years in each group; the mean follow tine was 39.1 (12-80), 48.2 (16-79), and 36.8 (12-80) months after RARP; mean pre-RARP PSA was 13.1, 19.2, and 12.4 ng/mL. In the BCR+ group, 15.0% cases with PSM+. In the BCR- group, the PSM+ cases were 19.1%. In the 41 patients with PSM+, there were 3 (9.1%) with BCR+ during the follow-up. In the 178 patients who were PSM-, 17 (9.5%) cases developed BCR+. The mean BCR time after RARP was 9.4 (4-28) months.
Conclusion:
Our limited data indicate that surgical margin status is not an independent predictor of PSA recurrence in patients who underwent RARP as definitive local therapy for prostate cancer.