達文西攝護腺全切除於高風險的病人的預後
黃韋銘、李高漢、黃冠華1、廖建華、劉建良、沈坤宏、賴韋宏2
奇美醫學中心 外科部 泌尿外科 ，1泌尿腫瘤科；
2戴德森醫療財團法人嘉義基督教醫院 外科部 泌尿科
Outcome of Robotic-assisted Radical Prostatectomy in High Risk Patient
Ng Woei Ming, Kau Han Lee, Steven Kuan-Hua Huang1, Alex Chien-Hwa Liao, Chang-Liang Liu , Kun-Hung Shen , Wei-Hong Lai2
Division of Urology, Department of Surgery, Division of Uro-Oncology1,
Chi Mei Medical Center, Tainan, Taiwan;
Division of Urology2, Department of Surgery,
Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose:
Recently, there has been considerable interest in the role of radical prostatectomy (RP) in men with high‑risk prostate cancer. The objective of our study is to report the outcome of upfront RP in our single medical center patients with high-risk prostate cancer (Stage ≥ cT3, a pre-operative serum prostate specific antigen [PSA] >20 ng/ml or a biopsy Gleason score [GS] 8‑10).
Materials and Methods:
From April 2012 to May 2015, there were 117 patients of prostate cancer underwent robotic-assisted radical prostatectomy with bilateral pelvic lymphadenectomy. There was 64 (54.7%) high risk patients. The tumor’s characteristic, intra-operative statuses, post-operative follows up outcome were analysis.
Results:
The mean age was 68-year-old. Patients with 1 high risk features was 35 (54.7%), 2 features was 24 (37.5%), 3 features was 5 (7.8%). The mean operative console time was 203.5min (113-465), estimated blood loss was 423ml (50-1700). The mean length of stay was 8.8 days (5-27). Complication rate was 34%. For the pathology finding, Positive surgical margin was found in 27 patients (42%), upstaging was found in 10 of 35 cT2 patients (29%), down staging was found in 12 of 29 cT3 patients (41%). For the outcome: Biochemical failure was noted in 6 (9%) patients. 6 month continence rate was 86%, mean post-operative International Index of Erectile Function (IIEF-5) score was 17.
Conclusion:
Possibility of down staging in 41.4% patients and downgrading in 19.4%.Radical prostatectomy provides accurate pathologic staging of patients with high risk prostate cancer, allows better stratification of patients for further adjuvant therapy and either as an initial approach or part of a multimodal regimen, can provide durable local control.