機器人輔助和純腹腔鏡前列腺切除術於高風險前列腺癌患者：
台中榮總單一團隊經驗
謝享宸、楊晨洸
台中榮民總醫院 外科部 泌尿外科
Robot-assisted and pure laparoscopic prostatectomy in high risk prostate cancer: TCVGH single team experience
Hsiang-Chen Hsieh, Chun-Kuang Yang
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan
Purpose:
To present the comparison of robot-assisted laparoscopic prostatectomy (RaLRP) and laparoscopic prostatectomy (LRP) in high risk prostate cancer by a single team with trifecta results included oncological outcomes, contient and potency of patients.
Materials and Methods:
The database of a single medical center and an single team on TCVGH was reviewed retrospectively, and patients who underwent robot-assisted laparoscopic prostatectomy (RaLRP) & laparoscopic prostatectomy (LRP) in high risk prostate cancer were enrolled. The patient demographics, trifecta results, perioperative details, and postoperative outcomes were collected and analyzed.
Results:
We identified 212 (107 with LRP and 105 with RaLRP) patients who underwent radical prostatectomy for high risk prostate cancer. The rate of positive surgical margin (PSM) were 11.1 & 7.6% in pT2, 21.4 & 21.05% in pT3a and 41.3 & 46.4% in pT3b. The number of dissected lymph node were 16.3 (+4.2) and 16.9 (+5.5) respectively. Positive rate of lymph node were 17.7% (19/107) and 10.4% (11/105). The median follow-up period were 33.4 (+17.1) and 33.1 (+16.9) months. The 3-year biochemical recurrence rate were 9.09% (3/33) & 10.2% (4/39)in pT2, 16.6% (7/42) & 15.8% (6/38) in pT3a and 37.5% (12/32) & 50% (14/28) in pT3b. About continence, postoperative pad-free rates in 3 months follow-up were 89.7% and 92.8%, in 12 months follow-up were 91.3% and 93.7%. Only 1 case in RaLRP had anastomosis stricture and received laser urethrotomy. No patient need artificial sphincter. The potency to achieving intercourse were 33.7% (LRP) vs 62.1% (RaLRP) in patients underwent bilateral neurovascular bundle (NVB) preservation, and 9.6% vs 11.2% in patients underwent unilateral NVB. The decline of IIEF in all patient was >30%. The median operative time were 173.2 (+36.8) and 156.4 (+42.7) minutes. Blood loss were 141.3 (+89.8) and 142.9 (+92.3) c.c.. The post-operative hospital stay were 3.9 (+1.2) and 3.4 (+1.6) days. The days of Foley catheter use were 10.1 (+1.2) and 10.2 (+1.8) days. The complication rate were 9/107 (8.4%) and 8/105 (7.6%) respectively.
Conclusion:
LRP and RALRP performed by a single surgeon and medical team showed similar results in terms of safety and oncological outcomes. Higher pathological T stage was associated with increased rate of PSM and worsen biochemical recurrence rate. However, RaLRP can be considered in terms of postoperative quality of life than LRP with favorable outcomes about potency and urinary continence recovery.