Laparoskopska radikalna prostatektomija - iskustvo jednog centra
Sažetak
Minimalno invazivne tehnike, uključujući robotski-potpomognutu i laparoskopsku radikalnu prostatektomiju postale su operativne tehnike izbora za operativno lečenje karcinoma prostate. Cilj studije bio je proceniti i uporediti rezultate laparoskopske radikalne prostatektomije (LRP) i otvorene retropubične radikalne prostatektomije (ORRP) u pogledu bezbednosti, efikasnosti i onkološkog ishoda.
Ukupno 123 radikalne prostatektomije (RP) za nisko-rizični lokalizovani karcinom prostate obavljene su u periodu od januara 2016. do juna 2019. na Univerzitetskoj klinici za urologiju Skoplje. Od toga je 61 (49,6%) bila LRP, a 62 (50,4%) ORRP, uz prosečnu starost pacijenata 54 godine (33 do 67). Indikacije za operativni postupak bile su: patohistološki nalaz adenokarcinoma prostate, starost ≤ 70 godina, PSA <10ng/ml, Gleson-skor ≤ 7 (3 + 3 ili 3 + 4), negativna scintigrafija kostiju, stadijum ≤T2a, N0, M0. Svi pacijenti su sagledani kroz demografske podatke, nivoe PSA, Gleason-skora, trajanja operactivnog zahvata, konverzije iz LRP u ORRP, gubitaka krvi, perioperativnih komplikacija, uklanjanja operativnog katetera, transfuzija krvi, boravka u bolnici i onkološkog ishoda.
LRP se pokazao superiornijim u odnosu na ORRP, što je rezultovalo kraćim operativnim vremenom, manjim gubicima krvi (p < 0.5), kraćim vremenom za nastavak oralnog unosa hrane i tečnosti, kraćim postoperativnim boravkom u bolnici (p < 0.5) i manjim potrebama za analgetskom terapijom. Što se tiče onkološkog ishoda, primetili smo manje pozitivnih resekcionih ivica u grupi LRP (p < 0.5). Naši rezultati pokazuju da iako obe operativne tehnike predstavljaju bezbedne procedure i pružaju dobar kvalitet operativnog zahvata, u našoj seriji LRP je pokazala bolje rezultate u pogledu bezbednosti, efikasnosti i onkološkog ishoda.
Reference
Augustin H, Hammerer P, Graefen M, Palisaar J, Noldus J, Fernandez S, et al. Intraoperative and perioperative morbidity of contemporary radical retro-pubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002. Eur Urol 2003;43:113-8. [CrossRef] [PubMed]
Bill-Axelson A, Holmberg L, Garmo H, Rider J, Taari K, Busch C, et al. Radical prostatectomy or watchful waiting in early prostate cancer. New England Journal of Medicine 2014;370:932-42. [CrossRef] [PubMed]
Bill-Axelson A, Holmberg L, Garmo H, Taari K, Busch C, Nordling S, Häggman M, Andersson SO, Andrén O, Steineck G, Adami HO, Johansson JE. Radical Prosta-tectomy or Watchful Waiting in Prostate Cancer - 29-Year Follow-up. N Engl J Med 2018 Dec 13;379(24): 2319-2329. [CrossRef] [PubMed]
Bhayani SB, Pavlovich CP, Hsu TS, Sullivan W, Su Li. Prospective comparison of short-term convales-cence:Laparoscopic radical prostatectomy versusopen radical retropubic prostatectomy. Urology 2003;61: 612-616. [CrossRef] [PubMed]
Binder J, Kramer W. Robotically assisted laparoscopic radical prostatectomy. BJU Int 2001;87:408-10. [CrossRef] [PubMed]
Borgermann C, Loertzer H, Hammerer P, Fornara P, Graefen M, Rubben H. Problems, objective, and sub-stance of early detection of prostate cancer [in German]. Urologe A 2010;49:181-9. [CrossRef] [PubMed]
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. [CrossRef] [PubMed]
Carvalhal GF, Smith DS, Mager DE, Ramos C, Catalona WJ. Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng/ml or less. J Urol 1999;161:835-9. [CrossRef] [PubMed]
Coughlin GD, Yaxley JW, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retro-pubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol 2018;19: 1051. [CrossRef] [PubMed]
Curto F, Benijts J, Pansadoro A, Barmoshe S, Hoepffner JL, Mugnier C, et al. Nerve sparing laparo-scopic radical prostatectomy: our technique. Eur Urol 2006;49:344-52. [CrossRef] [PubMed]
Ferlay J EM, Lam F, Colombet M, Mery L, Pineros M, Znaor A, Soerjomataram I. et al. Global cancer obser-vatory: cancer today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today, Accessed 02 Februar
Fornara P, Zacharias M. Minimal invasiveness of laparoscopic radical prostatectomy: reality or dream? AktuelleUrol 2004;35:395-405. [CrossRef] [PubMed]
Fracalanza S, Ficarra V, Cavalleri S, Galfano A, Novara G, Mangano A, et al. Is robotically assisted laparo-scopic radical prostatectomy less invasive than retro-pubic radical prostatectomy? Results from a pros-pective, unrandomized, comparative study. BJU Int 2008;101:1145-9. [CrossRef] [PubMed]
Galli S, Simonato A, Bozzola A, Gregori A, Lissiani A, Scaburri A, Gaboardi F. Oncologic outcome and con-tinence recovery after laparoscopic radical prosta-tectomy: 3 years’ follow-up in a ‘‘second generation center’’. Eur Urol 2006;49:859-65. [CrossRef] [PubMed]
Guillonneau B, el-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G, et al. Laparoscopic radical prostatectomy:oncological evaluationafter 1000 cases at Montsouris Institute. J Urol 2003;169:1261-6. [CrossRef] [PubMed]
Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experi-ence. Urol Clin North Am 2001;28:555-65. [CrossRef] [PubMed]
Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU Guidelines on prostate cancer. Part 1: Screening, diagnosis, and treatment of clinically localised disease. European Urology 2011; 59:61-71. [CrossRef] [PubMed]
Heidenreich A, Pfister D. PSA persistence after radical prostatectomy needs more than standard therapeutic options to improve outcomes. BJU Int. 2019 Nov; 124(5):716-718. [CrossRef] [PubMed]
Jurczok A, Zacharias M, Wagner S, Hamza A, Fornara P. Prospective non-randomized evaluation of four mediators of the systemic response after extraperito-neal laparoscopic and open retropubic radical prosta-tectomy. BJU Int 2007;99:1461-6. [CrossRef] [PubMed]
Link RE, Su LM, Bhayani SB, Pavlovich CP. Making ends meet: A cost comparison of laparoscopic and open radical retropubic prostatectomy. J Urol 2004; 172:269-274. [CrossRef] [PubMed]
Mottet N, van den Bergh RCN, Briers E, Bourke L, Cornford P, De Santis M, et al. Guidelines recom-mendations for the various disease stages. In: EAU - EANM - ESTRO - ESUR – SIOG Guidelines on Prostate Cancer; Prostate cancer update March 2019, European Association of Urology 2019:90
Mottet N, van den Bergh RCN, Briers E, Bourke L, Cornford P, De Santis M, et al. Treatment. In: EAU - EANM - ESTRO - ESUR – SIOG Guidelines on Prostate Cancer; Prostate cancer update March 2019, European Association of Urology 2019:38-53.
Mouraviev V, Nosnik I, Sun L, Robertson CN, Walther P, Albala D, et al: Financial comparative analysis of minimally invasive surgery to open surgery for locali-zed prostate cancer: A singleinstitution experience. Urology 2007;69:311-314. [CrossRef] [PubMed]
Rassweiler J, Seemann O, Schulze M, Teber D, Hatzinger M, Frede T. Laparoscopic versus open radical prostatectomy: Acomparative study at a single institution. J Urol 2003;169:1689-1693. [CrossRef] [PubMed]
Sacco E, Prayer-Galetti T, Pinto F, Fracalanza S, Betto G, Pagano F, et al. Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up. BJU Int 2006;97:1234-41. [CrossRef] [PubMed]
Stolzenburg JU, Rabenalt R, DO M, Ho K, Dorschner W, Waldkirch E, al. Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. J Urol 2005;174:1271-5. [CrossRef] [PubMed]
Su LM, Link RE, Bhayani SB, Sullivan W, Pavlovich CP. Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology 2004; 64:123-7. [CrossRef] [PubMed]
Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982;128:492-7. [CrossRef] [PubMed]