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Inicio Actas Urológicas Españolas (English Edition) Oncologic results, functional outcomes, and complication rates of transperitonea...
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Vol. 39. Issue 2.
Pages 70-77 (March 2015)
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Vol. 39. Issue 2.
Pages 70-77 (March 2015)
Original article
Oncologic results, functional outcomes, and complication rates of transperitoneal robotic assisted radical prostatectomy: Single centre's experience
Resultados oncológicos, funcionales y complicaciones de la prostatectomía radical transperitoneal asistida por robot
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A. Ihsan-Tasci, A. Simsek
Corresponding author
simsek76@yahoo.com

Corresponding author.
, M.B. Dogukan-Torer, D. Sokmen, S. Sahin, A. Bitkin, V. Tugcu
Department of Urology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Estambul, Turkey
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Tables (4)
Table 1. Basic preoperative characteristics of all patients.
Table 2. The perioperative parameters of prostate cancer patients that underwent a RARP.
Table 3. Pathologic stage, postoperative Gleason score, positive surgical margin and biochemical recurrence rates of patients that underwent a different RARP approach.
Table 4. Comparison continence and potency rates in patients with different RARP approach.
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Abstract
Background

We report the operative details and short term oncologic and functional outcome of the first 334 Robotic-assisted radical prostatectomy experiences for organ confined prostate cancer.

Methods

From August 2009 to December 2012, details of 334 consecutive patients were retrospectively analyzed. The analyzed parameters included: preoperative, per-operative characteristics, postoperative minor and major complications, positive surgical margin continence, potency, and biochemical progression at the follow-up period.

Results

The classical extrafascial, interfascial, intrafascial and fascia sparing radical prostatectomy were performed in 31, 41, 200, and 62 cases, respectively. The mean operation time was 213.8±90.1min, and the mean estimated blood loss was 116.1±58.9cc during operation. A nerve-sparing procedure was performed bilaterally in 198 (59.3%) cases and unilaterally in 126 (37.7%) cases. The catheter was removed on postoperative day 9, 1±1.9. Surgical margin was positive in 36 (10.7%) patients. The overall, pT2, pT3a and pT3b PSM rates were 8 (2.4%), 12 (3.6%), 16 (4.8%) respectively and PSM and BCR rates were not statistically different among four approach (p>0.05). At the follow-up period, the continence rates were 74.4%, 80.4%, 80.5%, and 96.7% (p<0.001), and previously potent patients’ potency rates were 64.3%, 66.6%, 68.1%, and 74.5% (p>0.05), in classic extrafascial, interfascial, intrafascial, and fascia sparing intrafascial prostatectomy, respectively.

Conclusion

RARP is a safe and feasible technique in treatment of localized prostate cancer. Fascia sparing approach has better continence rate. This results need to be supported by new prospective, randomized studies.

Keywords:
Prostate cancer
RARP
Continence
Potency
PSM
BCR
Resumen
Antecedentes

Se presentan los detalles de la intervención y los resultados oncológicos y funcionales a corto plazo de las primeras 334 experiencias de prostatectomía radical asistida por robot para el cáncer de próstata órgano confinado.

Métodos

Entre agosto de 2009 y diciembre de 2012 se analizaron retrospectivamente los datos de 334 pacientes consecutivos. Los parámetros analizados fueron: preoperatorio, características peroperatorias, complicaciones postoperatorias menores y mayores, continencia de los márgenes quirúrgicos positivos y potencia y progresión bioquímica en el período de seguimiento.

Resultados

La prostatectomía radical clásica extrafascial, interfascial, intrafascial y de preservación de la fascia se realizó en 31, 41, 200 y 62 casos, respectivamente. El tiempo de operación promedio fue de 213,8±90,1min y la pérdida de sangre estimada media fue de 116,1±58,9cc durante la operación. Se llevó a cabo un procedimiento con preservación nerviosa de forma bilateral en 198 (59,3%) casos y de forma unilateral en 126 (37,7%) casos. El catéter se retiró en el día postoperatorio 9, 1±1,9. El margen quirúrgico fue positivo en 36 (10,7%) pacientes. Las tasas globales pT2, pT3a y pT3b de MQP fueron 8 (2,4%), 12 (3,6%), 16 (4,8%), respectivamente, y las tasas de margen quirúrgico positivo y tasa de recurrencia bioquímica no fueron estadísticamente diferentes entre los 4 abordajes (p>0,05). En el período de seguimiento las tasas de continencia fueron de 74,4, 80,4, 80,5 y 96,7% (p<0,001), y las tasas de potencia de pacientes previamente potentes fueron 64,3, 66,6, 68,1 y 74,5% (p>0,05), en la prostatectomía clásica extrafascial, interfascial, intrafascial y de preservación de la fascia, respectivamente.

Conclusión

La PRAR es una técnica segura y factible en el tratamiento del cáncer de próstata localizado. El abordaje con preservación de la fascia tiene una mejor tasa de continencia. Estos resultados necesitan el apoyo de nuevos estudios prospectivos y aleatorizados.

Palabras clave:
Cáncer de próstata
PRAR
Continencia
Potencia
MQP
TRB

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