Serie inicial de prostatectomía radical laparoscópica en un hospital general: revisión y comparativa de series nacionales e internacionales.
Initial Series Of Radical Prostatectomy In A General Hospital: Review And Comparative Of National And International Series
M. Crego Tapias1
, P. Puig Duran, B. Juaneda Castell, J. Segura Forcada, C. Vallejo Gil, L.L. Cortadellas Angel
Autor para correspondencia
marccrego@gmail.com
Correpondencia autor: Dr. M. Crego Tapias Servicio de Urología. Hospital de Granollers Avda. Francesc Ribas, s/n - 08400 Granollers (Barcelona) Tel.: 938 425 000
Correpondencia autor: Dr. M. Crego Tapias Servicio de Urología. Hospital de Granollers Avda. Francesc Ribas, s/n - 08400 Granollers (Barcelona) Tel.: 938 425 000
Servicio de Urología. Hospital General de Granollers. Barcelona.
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"apellidos" => "Crego Tapias" "email" => array:1 [ 0 => "marccrego@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Puig Duran" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Juaneda Castell" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Segura Forcada" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Vallejo Gil" ] 5 => array:2 [ "nombre" => "L.L." "apellidos" => "Cortadellas Angel" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología. Hospital General de Granollers. Barcelona." ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correpondencia autor: Dr. M. Crego Tapias Servicio de Urología. Hospital de Granollers Avda. Francesc Ribas, s/n - 08400 Granollers (Barcelona) Tel.: 938 425 000" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Initial Series Of Radical Prostatectomy In A General Hospital: Review And Comparative Of National And International Series" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-02-29" "fechaAceptado" => "2008-03-31" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec88717" "palabras" => array:3 [ 0 => "Cáncer próstata" 1 => "Prostatectomía radical" 2 => "Laparoscopia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec88718" "palabras" => array:3 [ 0 => "Prostate cancer" 1 => "Radical prostatectomy" 2 => "Laparoscopy" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Serie inicial de prostatectomía radical laparoscópica en un hospital general: revisión y comparativa de series nacionales e internacionales.</p> <span class="elsevierStyleSectionTitle">Introducción y objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La prostatectomía radical laparoscópica es una técnica que ha demostrado unos resultados oncológicos y funcionales competitivos, por lo que se ha convertido en un procedimiento rutinario en muchos centros punteros. No obstante, la dificultad de aprendizaje y su coste inicial, pueden cuestionar su implantación como técnica rutinaria, en centros que no sean de referencia.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio descriptivo de nuestra serie inicial analizando la técnica quirúrgica, resultados posquirúrgicos inmediatos, y oncológicos y funcionales a corto plazo, comparándolos con otras series en centros nacionales e internacionales.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De febrero 2006 a agosto 2007 realizamos 69 procedimientos laparoscópicos en nuestro centro, de los cuales 34 fueron prostatectomías radicales. La edad media de la serie fue de 63 años (50-72), con un peso prostático medio por ecografía transrectal de 35 gr. (17-72), y una mediana de PSA de 6 ng/ml (4-35). Los estadios clínicos fueron: T1c 59%, T2a 12%, T2b 17%, T2c 12%; con Gleason: 2+2 en 3%, 3+3 en 35%, 3+4 en 15%, 4+3 en 44%, 4+5 en 3%.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">De los 34 casos iniciados por laparoscopia, se terminaron 30, con un tiempo quirúrgico medio de 261 minutos (150-380). Se convirtieron 4 casos a cirugía abierta, 1 por enfisema subcutáneo, 1 por prolongación del tiempo quirúrgico, 1 por sangrado, 1 por lesión rectal.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los estadios patológicos fueron: pT2a 3%, pT2b 18%, pT2c 41%, pT3a 32%, pT3b 6%. Con Gleason de: 3+3 en 26%, 3+4 en 14%, 4+3 en 47%, 4+4 en 9%, 4+5 en 3%. Obtuvimos un 29% de márgenes positivos (50% pT3a, 20% pT3b, 20% pT2b, 10% pT2c).</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La continencia (0-1 compresas) al mes, fue del 62%, llegando al 84% a los 6 meses. La erección al mes, se conservó en un 50% de los pacientes, en los cuatro casos de disección intrafascial.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">la prostatectomía radical laparoscópica es una técnica de difícil aprendizaje, y exige un tiempo quirúrgico inicial superior a la cirugía abierta. No obstante, comprobamos que se trata de una técnica segura, con unos resultados oncológicos y funcionales competitivos, una recuperación temprana y un escaso sangrado, incluso en series iniciales. Por ello, también debería considerarse una opción para el tratamiento del cáncer de próstata en centros de segundo nivel.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction and objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The radical prostatectomy is a technique that has shown competitive oncological and functional results, that is why it has become to be a routine procedure in many leading centers. Nevertheless, the difficulty of learning and its initial cost, could question its implantation as a routine technique in centers that are not a point of reference.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">We have carried out a descriptive study of our initial series analyzing the surgical technique, post surgical immediate results, and oncological and functional short-term outcomes, comparing them with other series in national and international centers.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">From February, 2006 to August, 2007 we performed 69 laparoscopical procedures in our center, of which 34 were radical prostatectomies. The average age of the series were 63 years (50-72), with a prostate average weight by transrectal ultrasound of 35 gr. (17-72), and a median PSA of 6ng/ml (4-35). The clinical stages were: T1c 59%, T2a 12%, T2b 17%, T2c 12%; with Gleason combined of: 2+2 in 3%, 3+3 in 35%, 3+4 in 15%, 4+3 in 44%, 4+5 in 3%.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Out of the 34 cases initiated by laparoscopy, 30 were concluded laparoscopically, with a surgical average time of 261 minutes (150- 380). The pathological stages were: pT2a 3%, pT2b 18%, pT2c 41%, pT3a 32 %, pT3b 6%. With Gleason of: 3+3 in 26%, 3+4 in 14%, 4+3 in 47%, 4+4 in 9%, 4+5 in 3%. We obtained 29 % of positive margins (50% pT3a, 20% pT3b, 20% pT2b, 10% pT2c). Four cases were converted to open surgery, one due to subcutaneous emphysema, one to enlarged surgical time, one bleeding, and one rectal injury.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The continence (0-1 pads) at the first month was 62%, reaching 84% at 6 months.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The erection, remained in 50% of the patients at the first month, in the four cases of intrafascial dissection.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic radical prostatectomy is a technique of difficult learning, and initially requires higher surgical time than open surgery.Nevertheless, we prove that it is a reliable technique with competitive oncological and functional results, earlyrecovery and little bleeding even in the initial series. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 0 | 5 | 5 |
| 2024 Septiembre | 0 | 10 | 10 |
| 2024 Agosto | 0 | 4 | 4 |
| 2024 Julio | 0 | 8 | 8 |
| 2024 Junio | 0 | 11 | 11 |
| 2024 Mayo | 0 | 5 | 5 |
| 2024 Abril | 0 | 10 | 10 |
| 2024 Marzo | 0 | 36 | 36 |
| 2024 Febrero | 0 | 27 | 27 |
| 2024 Enero | 0 | 7 | 7 |
| 2023 Diciembre | 0 | 20 | 20 |
| 2023 Noviembre | 0 | 18 | 18 |
| 2023 Octubre | 0 | 28 | 28 |
| 2023 Septiembre | 0 | 15 | 15 |
| 2023 Agosto | 0 | 23 | 23 |
| 2023 Julio | 0 | 34 | 34 |
| 2023 Junio | 0 | 1 | 1 |
| 2023 Mayo | 0 | 7 | 7 |
| 2023 Abril | 0 | 1 | 1 |
| 2023 Marzo | 1 | 6 | 7 |
| 2023 Febrero | 0 | 3 | 3 |
| 2022 Diciembre | 0 | 7 | 7 |
| 2022 Noviembre | 0 | 4 | 4 |
| 2022 Octubre | 0 | 8 | 8 |
| 2022 Septiembre | 0 | 5 | 5 |
| 2022 Agosto | 0 | 13 | 13 |
| 2022 Julio | 0 | 3 | 3 |
| 2022 Mayo | 0 | 5 | 5 |
| 2022 Abril | 0 | 2 | 2 |
| 2022 Marzo | 0 | 2 | 2 |
| 2022 Enero | 0 | 1 | 1 |
| 2021 Diciembre | 0 | 4 | 4 |
| 2021 Noviembre | 0 | 5 | 5 |
| 2021 Octubre | 0 | 2 | 2 |
| 2021 Septiembre | 0 | 1 | 1 |
| 2021 Agosto | 0 | 3 | 3 |
| 2021 Julio | 0 | 2 | 2 |
| 2021 Junio | 0 | 2 | 2 |
| 2021 Mayo | 0 | 2 | 2 |
| 2021 Abril | 0 | 3 | 3 |
| 2021 Marzo | 0 | 1 | 1 |
| 2021 Febrero | 0 | 4 | 4 |
| 2021 Enero | 0 | 5 | 5 |
| 2020 Diciembre | 0 | 2 | 2 |
| 2020 Octubre | 0 | 1 | 1 |
| 2020 Septiembre | 0 | 8 | 8 |
| 2020 Agosto | 0 | 6 | 6 |
| 2020 Julio | 0 | 4 | 4 |
| 2020 Junio | 0 | 4 | 4 |
| 2020 Mayo | 0 | 8 | 8 |
| 2020 Abril | 0 | 4 | 4 |
| 2020 Marzo | 0 | 7 | 7 |
| 2020 Febrero | 0 | 6 | 6 |
| 2020 Enero | 0 | 16 | 16 |
| 2019 Diciembre | 0 | 30 | 30 |
| 2019 Noviembre | 0 | 14 | 14 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 0 | 5 | 5 |
| 2019 Agosto | 0 | 7 | 7 |
| 2019 Julio | 0 | 12 | 12 |
| 2019 Junio | 0 | 14 | 14 |
| 2019 Mayo | 0 | 52 | 52 |
| 2019 Abril | 0 | 58 | 58 |
| 2019 Marzo | 0 | 6 | 6 |
| 2019 Febrero | 0 | 16 | 16 |
| 2019 Enero | 0 | 7 | 7 |
| 2018 Diciembre | 0 | 4 | 4 |
| 2018 Noviembre | 0 | 18 | 18 |
| 2018 Octubre | 0 | 12 | 12 |
| 2018 Febrero | 0 | 3 | 3 |
| 2018 Enero | 0 | 1 | 1 |
| 2017 Noviembre | 2 | 4 | 6 |
| 2017 Octubre | 3 | 8 | 11 |
| 2017 Septiembre | 3 | 2 | 5 |
| 2017 Agosto | 5 | 3 | 8 |
| 2017 Julio | 5 | 0 | 5 |
| 2017 Junio | 6 | 8 | 14 |
| 2017 Mayo | 8 | 5 | 13 |
| 2017 Abril | 9 | 1 | 10 |
| 2017 Marzo | 6 | 1 | 7 |
| 2017 Febrero | 1 | 2 | 3 |
| 2017 Enero | 1 | 3 | 4 |
| 2016 Diciembre | 13 | 4 | 17 |
| 2016 Noviembre | 20 | 2 | 22 |
| 2016 Octubre | 36 | 1 | 37 |
| 2016 Septiembre | 14 | 1 | 15 |
| 2016 Agosto | 11 | 4 | 15 |
| 2016 Julio | 12 | 1 | 13 |
| 2016 Junio | 14 | 14 | 28 |
| 2016 Mayo | 13 | 12 | 25 |
| 2016 Abril | 12 | 10 | 22 |
| 2016 Marzo | 14 | 13 | 27 |
| 2016 Febrero | 12 | 14 | 26 |
| 2016 Enero | 14 | 13 | 27 |
| 2015 Diciembre | 10 | 11 | 21 |
| 2015 Noviembre | 8 | 10 | 18 |
| 2015 Octubre | 12 | 14 | 26 |
| 2015 Septiembre | 11 | 7 | 18 |
| 2015 Agosto | 6 | 1 | 7 |
| 2015 Julio | 12 | 3 | 15 |
| 2015 Junio | 3 | 2 | 5 |
| 2015 Mayo | 4 | 1 | 5 |
| 2015 Abril | 6 | 7 | 13 |
| 2015 Marzo | 4 | 2 | 6 |
| 2015 Febrero | 3 | 3 | 6 |
| 2015 Enero | 6 | 4 | 10 |
| 2014 Diciembre | 12 | 5 | 17 |
| 2014 Noviembre | 6 | 3 | 9 |
| 2014 Octubre | 11 | 4 | 15 |
| 2014 Septiembre | 15 | 1 | 16 |
| 2014 Agosto | 6 | 2 | 8 |
| 2014 Julio | 18 | 2 | 20 |
| 2014 Junio | 8 | 3 | 11 |
| 2014 Mayo | 4 | 3 | 7 |
| 2014 Abril | 4 | 3 | 7 |
| 2014 Marzo | 12 | 6 | 18 |
| 2014 Febrero | 5 | 4 | 9 |
| 2014 Enero | 3 | 2 | 5 |
| 2013 Diciembre | 4 | 2 | 6 |
| 2013 Noviembre | 9 | 4 | 13 |
| 2013 Octubre | 4 | 7 | 11 |
| 2013 Septiembre | 7 | 5 | 12 |
| 2013 Agosto | 4 | 4 | 8 |
| 2013 Julio | 2 | 1 | 3 |
| 2008 Septiembre | 234 | 0 | 234 |
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