Açık ve robot yardımlı laparoskopik radikal prostatektominin erken dönem onkolojik ve fonksiyonel sonuçları açısından karşılaştırılması
Abstract
Amaç: Radikal prostatektomi (RP), son yirmi yılda açık cerrahiden minimal invaziv cerrahiye kayda değer bir dönüşüm geçirdi. Çalışmamızda lokalize prostat kanseri nedeniyle açık ve robot yardımlı RP yapılan hastaları erken dönem onkolojik ve fonksiyonel sonuçları açısından karşılaştırılmayı amaçladık.
Gereç ve Yöntem: Çalışmamıza Ocak 2009 ile Ocak 2014 tarihleri arasında prostat kanseri tanısı alıp RP yapılan 537 hasta dâhil edildi. (Açık retropubik radikal prostatektomi (ARRP)=387, robot yardımlı laparoskopik radikal prostatektomi (RYRP)=150). Hastaların demografik verileri, perioperatif ve postoperatif sonuçları iki grup arasında karşılaştırıldı.
Bulgular: Hastaların ortalama yaşı ARRP grubunda 62,9 (46-76), RYRP grubunda ise 61,1 (42-76) yıl idi. Ortalama hastanede kalış süresi, üretral kateterizasyon süresi ve kan transfüzyonu ihtiyacının RYRP grubunda anlamlı olarak daha kısa olduğu görüldü. Cerrahi sınır pozitifliği oranlarının pT2 evreye sahip olanlarda ARRP ve RYRP grubu için sırasıyla %16,3 ve %20 (p=0,412), pT3 evreye sahip olanlarda ise ARRP ve RYRP grubunda sırasıyla %40,9 ve %68,8 (p=0,05) olduğu görüldü. Ortalama takip süresi, ARRP grubunda 30,6 (3-64) ay, RYRP grubunda ise 11,3 (1-24) ay olarak hesaplandı. Takipte RYRP grubunda anastomoz darlığı ve biyokimyasal rekürrens gelişiminin daha az olduğu görüldü (%3,9 vs %29,9 p<0,05, %6,3 vs %20,1 p=0,01). RP sonrası bir yıllık süre içerisinde takipte kontinans oranları açısından her iki grup arasında anlamlı fark saptanmazken (p=0,184), takip süresi 12 ay ve üzerinde olan hastalarda; RYRP grubunda kontinan hasta oranın daha fazla olduğu görüldü (p<0.05).
Sonuç: Her iki yaklaşım benzer onkolojik sonuçlar göstermekle birlikte daha iyi fonksiyonel sonuçları ile RYRP lokalize prostat kanseri cerrahisi için standart tedavi olma yolunda hızla ilerlemektedir.
Keywords
Prostat kanseri radikal prostatektomi robotik cerrahi idrar inkontinası biyokimyasal rekürrens
References
- Siegel RL, Miller KD, Jemal A. Cancer statistics. 2020. CA Cancer J Clin 2020 Jan;70(1):7-30.
- Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J Urol 2018; 199: 683-90.
- Novara G, Ficarra V, Rosen RC, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot assisted radical prostatectomy. Eur Urol 2012; 62: 431-52.
- Mazzone E, Mistretta FA, Knipper S, et al. Contemporary national assessment of robot-assisted surgery rates and total hospital charges for major surgical uro-oncological procedures in the United States. J Endourol 2019; 33: 438–47.
- Clavien PA, Strasberg SM. Severity grading of surgical complications. Ann Surg 2009; 250 (2):197-8.
- D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280: 969-74.
- Seikkula H, Syvanen K. T, Kurki S, et al. Role of ultrasensitive prostate-specific antigen in the follow-up of prostate cancer after radical prostatectomy. Urol Oncol 2015; 33: 16.e1-16.e7.
- Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 2nd Consultation on Incontinence. United Kingdom: Health Publication; 2002.
- Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 1983; 4: 473–85.
- Eastham J, Tokuda Y, Scardino P. Trends in radical prostatectomy. Intl J Urol 2009; 16: 151–60.
- Smith JA Jr, Chan RC, Chang SS, et al. A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol 2007; 178 (6): 2385–90.
- Atug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R. Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes. Eur Urol 2006; 49 (5): 866-71.
- Menon M, Shrivastava A, Kaul S, et al. Vattikuti İnstitute Prostatectomy: comtemporary technique and analysis of results. Eur Urol 2007; 57: 648-58.
- Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int 2007; 99: 1109-12.
- Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016; 388: 1057–66.
- Tewari A, Srivasatava A, Menon M, members of the VIP team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 2003; 92: 205–10.
- Doumerc N, Yuen C, Savdie R, et al. Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. BJU Int 2010; 106: 378-84.
- Sooriakumaran P, Pini G, Nyberg T, et al. Erectile function and oncologic outcomes following open retropubic and robot-assisted radical prostatectomy: results from the LAParoscopic Prostatectomy Robot Open Trial. Eur Urol 2018; 73: 618–27.
- Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assesment after 2766 procedures. Cancer 2007;110:1951-8.
- Han M, Partin AW, Chan DY, Walsh PC. An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series. J Urol 2004; 171: 23–6.
- Drouin SJ, Vaessen C, Hupertan V, et al. Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer. World J Urol 2009; 27 (5): 599–605.
- Nelson JB. Debate: open radicalprostatectomy vs. laparoscopic vs. robotic. Urol Oncol 2007; 25: 490–3.
- Haese A, Knipper S, Isbarn H, et al. A comparative study of robot-assisted and open radical prostatectomy in 10790 men treated by highly trained surgeons for both procedures. BJU Int 2019; 123: 1031–40.
- Pompe RS, Beyer B, Haese A, et al. Postoperative complications of contemporary open and robot-assisted laparoscopic radical prostatectomy usingstandardised reporting systems. BJU Int 2018; 122: 801–7.
- Nelson B, Kaufman M, Broughton G, et al. Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. J Urol 2007; 177: 929-31.
- Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting the learning curve and beyond: initial 200 cases. J Urol 2005; 174: 269-72.
- Menon M, Tewari A, Vattikuti Institute Prostatectomy Team. Robotic radical prostatectomy and the Vattikuti Urology Institute technique: an interim analysis of results and technical points. Urology 2003; 61: 15–20.
- Quinlan DM, Epstein JI, Carter BS, Walsh PC. Sexual function following radical prostatectomy: Influence of preservation of neurovascular bundles. J Urol 1991; 145: 998-1002.
- Krambeck AE, DiMarco DS, Rangel LJ, et al. Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot‐assisted techniques. BJU international 2009; 103 (4): 448-53.
- Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 2009; 55: 1037–63.
- Sujenthiran A, Nossiter J, Parry M, et al. National cohort study comparing severe medium-term urinary complications after robot-assisted vs laparoscopic vs retropubic open radical prostatectomy. BJU Int 2018; 121: 445–52.
- Penson DF, McLerran D, Feng Z, et al. 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol 2005; 173: 1701-5.
- Frota R, Turna B, Barros R, Gill IS. Comparison of radical prostatectomy techniques: open, laparoscopic and robotic assisted. Int Braz J Urol 2008; 34: 259-69.
- Lepor H, Kaci L, Xue X. Continence following radical retropubic prostatectomy using self-reporting instruments. J Urol 2004; 171: 1212-5.
- Menon M, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody J. Vattikuti İnstitute Prostatectomy: comtemporary technique and analysis of results. Eur Urol 2007; 57: 648-58.
- Novara G, Ficarra V, D'elia C, et al. Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol 2010 Sep; 184 (3): 1028-33.
- Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2012 Sep; 62 (3): 405-17.
- Ferronha F, Barros F, Santos VV, Ravery V, Delmas V. Is there any evidence of superiority between retropubic, laparoscopic or robot-assisted radical prostatectomy. Int Braz J Urol 2011; 37 (2): 146-60.
- Samadi DB, Muntner P, Nabizada-Pace F, Brajtbord JS, Carlucci J, Lavery HJ. Improvements in robot-assisted prostatectomy: the effect of surgeon experience and technical changes on oncologic ve and functional outcomes. J Endourol 2010; 24: 1105–10.
Comparison of early oncologic and functional results of open and robot-assisted laparoscopic radical prostatectomy
Abstract
Aim: Radical prostatectomy (RP) has undergone a remarkable transformation from open surgery to minimally invasive surgery over the past two decades. In our study, we aimed to compare patients who underwent open (ORRP) and robot-assisted laparoscopic radical prostatectomy (RARP) for localized prostate cancer in terms of early oncological and functional outcomes.
Material and Methods: Our study included 537 patients who were diagnosed with prostate cancer and underwent RP between January 2009 and January 2014. (Open retropubic radical prostatectomy (ORRP)=387, robot-assisted laparoscopic radical prostatectomy (RARP)=150). Demographic data, perioperative and postoperative results of the patients were compared between the two groups.
Results: The mean age of the patients was 62.9 (46-76) in the ORRP group and 61.1 (42-76) years in the RARP group. It was observed that the mean hospital stay, urethral catheterization time, and blood transfusion requirement were significantly shorter in the RARP group. Surgical margin positivity rates were 16.3% and 20% (p=0.412) for the ORRP and RARP groups, respectively, in those with pT2 stage, and 40.9% and 68.8% in the ORRP and RARP groups, respectively, in patients with pT3 stage (p= 0.05). The mean follow-up period was 30.6 (3-64) months in the ORRP group and 11.3 (1-24) months in the RARP group. At follow-up, anastomotic stricture and biochemical recurrence were observed to be less in the RARP group (3.9% vs. 29.9% p<0.05, 6.3% vs 20.1% p=0.01). While no significant difference was found between the two groups in terms of continence rates in the first year of follow-up period after RP (p=0.184), in patients with a follow-up period of 12 months or more; It was observed after first year that the rate of continent patients continence rates were higher in the RARP group (p<0.05).
Conclusion: Although both approaches show similar oncological results, with better functional results, RARP is rapidly progressing to become the standard treatment for localized prostate cancer surgery.
Keywords
Prostate cancer radical prostatectomy robotic surgery urinary incontinence biochemical recurrence
References
- Siegel RL, Miller KD, Jemal A. Cancer statistics. 2020. CA Cancer J Clin 2020 Jan;70(1):7-30.
- Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J Urol 2018; 199: 683-90.
- Novara G, Ficarra V, Rosen RC, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot assisted radical prostatectomy. Eur Urol 2012; 62: 431-52.
- Mazzone E, Mistretta FA, Knipper S, et al. Contemporary national assessment of robot-assisted surgery rates and total hospital charges for major surgical uro-oncological procedures in the United States. J Endourol 2019; 33: 438–47.
- Clavien PA, Strasberg SM. Severity grading of surgical complications. Ann Surg 2009; 250 (2):197-8.
- D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280: 969-74.
- Seikkula H, Syvanen K. T, Kurki S, et al. Role of ultrasensitive prostate-specific antigen in the follow-up of prostate cancer after radical prostatectomy. Urol Oncol 2015; 33: 16.e1-16.e7.
- Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 2nd Consultation on Incontinence. United Kingdom: Health Publication; 2002.
- Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 1983; 4: 473–85.
- Eastham J, Tokuda Y, Scardino P. Trends in radical prostatectomy. Intl J Urol 2009; 16: 151–60.
- Smith JA Jr, Chan RC, Chang SS, et al. A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol 2007; 178 (6): 2385–90.
- Atug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R. Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes. Eur Urol 2006; 49 (5): 866-71.
- Menon M, Shrivastava A, Kaul S, et al. Vattikuti İnstitute Prostatectomy: comtemporary technique and analysis of results. Eur Urol 2007; 57: 648-58.
- Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int 2007; 99: 1109-12.
- Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016; 388: 1057–66.
- Tewari A, Srivasatava A, Menon M, members of the VIP team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 2003; 92: 205–10.
- Doumerc N, Yuen C, Savdie R, et al. Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. BJU Int 2010; 106: 378-84.
- Sooriakumaran P, Pini G, Nyberg T, et al. Erectile function and oncologic outcomes following open retropubic and robot-assisted radical prostatectomy: results from the LAParoscopic Prostatectomy Robot Open Trial. Eur Urol 2018; 73: 618–27.
- Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assesment after 2766 procedures. Cancer 2007;110:1951-8.
- Han M, Partin AW, Chan DY, Walsh PC. An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series. J Urol 2004; 171: 23–6.
- Drouin SJ, Vaessen C, Hupertan V, et al. Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer. World J Urol 2009; 27 (5): 599–605.
- Nelson JB. Debate: open radicalprostatectomy vs. laparoscopic vs. robotic. Urol Oncol 2007; 25: 490–3.
- Haese A, Knipper S, Isbarn H, et al. A comparative study of robot-assisted and open radical prostatectomy in 10790 men treated by highly trained surgeons for both procedures. BJU Int 2019; 123: 1031–40.
- Pompe RS, Beyer B, Haese A, et al. Postoperative complications of contemporary open and robot-assisted laparoscopic radical prostatectomy usingstandardised reporting systems. BJU Int 2018; 122: 801–7.
- Nelson B, Kaufman M, Broughton G, et al. Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. J Urol 2007; 177: 929-31.
- Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting the learning curve and beyond: initial 200 cases. J Urol 2005; 174: 269-72.
- Menon M, Tewari A, Vattikuti Institute Prostatectomy Team. Robotic radical prostatectomy and the Vattikuti Urology Institute technique: an interim analysis of results and technical points. Urology 2003; 61: 15–20.
- Quinlan DM, Epstein JI, Carter BS, Walsh PC. Sexual function following radical prostatectomy: Influence of preservation of neurovascular bundles. J Urol 1991; 145: 998-1002.
- Krambeck AE, DiMarco DS, Rangel LJ, et al. Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot‐assisted techniques. BJU international 2009; 103 (4): 448-53.
- Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 2009; 55: 1037–63.
- Sujenthiran A, Nossiter J, Parry M, et al. National cohort study comparing severe medium-term urinary complications after robot-assisted vs laparoscopic vs retropubic open radical prostatectomy. BJU Int 2018; 121: 445–52.
- Penson DF, McLerran D, Feng Z, et al. 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol 2005; 173: 1701-5.
- Frota R, Turna B, Barros R, Gill IS. Comparison of radical prostatectomy techniques: open, laparoscopic and robotic assisted. Int Braz J Urol 2008; 34: 259-69.
- Lepor H, Kaci L, Xue X. Continence following radical retropubic prostatectomy using self-reporting instruments. J Urol 2004; 171: 1212-5.
- Menon M, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody J. Vattikuti İnstitute Prostatectomy: comtemporary technique and analysis of results. Eur Urol 2007; 57: 648-58.
- Novara G, Ficarra V, D'elia C, et al. Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol 2010 Sep; 184 (3): 1028-33.
- Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2012 Sep; 62 (3): 405-17.
- Ferronha F, Barros F, Santos VV, Ravery V, Delmas V. Is there any evidence of superiority between retropubic, laparoscopic or robot-assisted radical prostatectomy. Int Braz J Urol 2011; 37 (2): 146-60.
- Samadi DB, Muntner P, Nabizada-Pace F, Brajtbord JS, Carlucci J, Lavery HJ. Improvements in robot-assisted prostatectomy: the effect of surgeon experience and technical changes on oncologic ve and functional outcomes. J Endourol 2010; 24: 1105–10.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 12, 2022 |
| Submission Date | March 4, 2022 |
| Published in Issue | Year 2022 |