Açık ve robot yardımlı laparoskopik radikal prostatektominin erken dönem onkolojik ve fonksiyonel sonuçları açısından karşılaştırılması

Serdar Kalemci; Kasım Emre Ergün; Tuncer Bahçeci; Fuat Kızılay; Burak Turna

doi:10.19161/etd.1168102

TR EN

Açık ve robot yardımlı laparoskopik radikal prostatektominin erken dönem onkolojik ve fonksiyonel sonuçları açısından karşılaştırılması

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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Ayrıntılar

Birincil Dil

Türkçe

Konular

Sağlık Kurumları Yönetimi

Bölüm

Araştırma Makalesi

Yazarlar

Serdar Kalemci ^*
0000-0002-9629-5258
Türkiye

Kasım Emre Ergün
0000-0002-6472-6156
Türkiye

Tuncer Bahçeci
0000-0002-3178-9169
Türkiye

Fuat Kızılay
0000-0003-1856-0404
Türkiye

Burak Turna
0000-0002-3548-2236
Türkiye

Yayımlanma Tarihi

12 Eylül 2022

Gönderilme Tarihi

4 Mart 2022

Kabul Tarihi

27 Mart 2022

Yayımlandığı Sayı

Yıl 2022 Cilt: 61 Sayı: 3

DOI

https://doi.org/10.19161/etd.1168102

IZ

https://izlik.org/JA35PP53DY

Kaynak Göster

RIS / Bibtex

Vancouver

1.Serdar Kalemci, Kasım Emre Ergün, Tuncer Bahçeci, Fuat Kızılay, Burak Turna. Açık ve robot yardımlı laparoskopik radikal prostatektominin erken dönem onkolojik ve fonksiyonel sonuçları açısından karşılaştırılması. ETD. 01 Eylül 2022;61(3):403-10. doi:10.19161/etd.1168102