拯救性機器手臂根除攝護腺切除術-十八例經驗報告
歐宴泉、翁瑋駿、黃立華、許兆畬、林益聖、童敏哲
童綜合醫院 外科部 泌尿科
Salvage Robotic-Assisted Laparoscopic Radical Prostatectomy：
Experience with 18 cases
Yen Chuan Ou, Wei-Chun Weng, Li-Hua Huang, Chao-Yu Shu, Yi-Sheng Lin, Min-Che Tung
Division of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
Objectives: To report the perioperative, functional and oncological outcomes of salvage robot-assisted laparoscopic prostatectomy (S-RaRP).
Methods: Eighteen patients received S-RaRP and enrolled to this study. Mean age was 67.8(51-84)yrs. PSA level at Initial diagnosis ranged from 3.4-51.3 ng/ml with mean14.3 ng/ml. Initial clinical stage T1/T2/T3 was 7/8/1 patients. Initial mean tumor percentage in transrectal ultrasound guiding biopsy was 19.14%(4-80%). Initial mean Gleason score was 6.93, and Gleason score ≥8 in 22.22% (4/18). Risk classification low/intermediate/high was in 5, 3 and 10 cases, respectively. Initial definitive treatment was external irradiation in 14 cases, cyberknife in two and high intensity focused ultrasound (HIFU) in two. Combined with androgen-deprivation therapy (ADT) was 8 (44.4%) patients. Nadir PSA level after definitive treatment ranged from 0.014-8.8 ng/ml with mean1.21 ng/ml. PSA level at S-RARP ranged 0.558-25 ng/ml with mean 6.69 ng/ml. Duration from definitive treatment to S-RARP range from 14 to 103 months with mean 36.5 months. Results: Clinical stage at S-RARP was T2N0/T3N0/T3N1 in12 case/5 case/one case. Mean console time was 136.9 (105-170) min (ranged 105-170 min). Estimated Blood loss was 99.6 ml (30-160 ml). Four patients suffered from complication (Clavien I: 2, Clavien III:2), intra-operative bladder tear with repair in one patient, penile ecchymosis after sex intercourse at post-operative day (POD) 28 in one patient, two patients underwent anastomotic stricture, one patient received urethral sounding once, another patients need to urethral sounding every two-three months after his urethral Foley’s catheter dislodge at POD 6, urethral injury during re-insertion of Foley catheter at local hospital. Final pathology pT2N0/T3N0/T3N1 in 10/6/2 and mean LN yield was 9.8 (7-13). Mean tumor volume was 5.46 cm3 and tumor percentage 14.36% (1-40%). Positive surgical margin was 27.8%(5/18). Contience rate with zero pad in 72.2% (13/18), the timing from 2 weeks to one year after removal of foley catheter. Mild stress urinary incontinence (one-two pad/ day) in 27.8% (5/18). Neurovascular bundle preservation in 3 patient and postoperatively 2 patient with potent. Mean post-operative followup period from 4 to 50 months with mean 38.8 months. Biochemical recurrence (BCR)-free in 15 (83.3%) was noted.
Conclusions: Salvage Robotic-Assisted Laparoscopic Prostatectomy is a technically feasible operation with low complication. Operative time was increased but no significantly increased blood loss. Continence rate was good. Potency rate was acceptable. Short-term oncological outcomes are encouraging, however longer follow-up is necessary with to draw significant conclusions.