Laparoskopik Radikal Prostatektomi Uygulanan Hastaların Cerrahi, Fonksiyonel ve Onkolojik Sonuçlarının Değerlendirilmesi

Öz

Amaç: Makale ile Akdeniz Üniversitesi Tıp Fakültesi Hastanesi Üroloji kliniğinde 2004-2007 yılları arasında prostat kanseri nedeniyle laparoskopik radikal prostatektomi yapılan ilk 140 olgunun cerrahi sonuçları ile 24 aylık takibi olan 88 hastanın onkolojik ve fonksiyonel sonuçlarının sunulması planlanmıştır. Gereç ve Yöntemler: Ekim 2004 - Ağustos 2007 tarihleri arasında klinik lokalize prostat kanseri tanısı konulan 140 hasta laparoskopik radikal prostatektomi ile tedavi edildi. 140 hastanın ameliyat verileri ayrıntılı olarak kayıt altına alındı. Toplam 88 hastanın ise ameliyat sonrası 3, 6, 9, 12, 18 ve 24. ay PSA değerleri, kontinans durumları ve ereksiyon kaliteleri değerlendirildi. Bulgular: Serimizde ortalama ameliyat ve bu sürenin içinde yer alan üretro-vezikal anastomoz sürelerinin median değerleri sırasıyla 225 ve 30 dakika olup, ortalama üretral kateterizasyon ve hastanede kalış sürelerinin median değerleri ise sırasıyla 8 ve 4 gün olarak gerçekleşmiştir. Patolojik değerlendirme yönünden hastaların sonuçları irdelendiğinde prognostik öneme sahip cerrahi sınır pozitifliği oranları, pT2 ve pT3 olgularda, sırasıyla %6.0, %40.9 olarak elde edilmiştir. Fonksiyonel açıdan, uretral kateter alınmasını takip eden ilk 3 ay içindeki tam kontinans oranı %69.2 iken, ortalama 24 aylık takip dönemindeki tam kontinans oranı %90’lara ulaşmaktadır. Serimizde iki taraflı sinir koruyucu yaklaşım yapılan hastaların %68.2’de ve tek taraflı sinir koruyucu yaklaşım uygulananların %57.1’inde 24 aylık takip sonunda yardımcı medikal tedavi ile başarılı ereksiyon oranları tespit edilmiştir. Sonuç: Laparoskopik radikal prostatektomi ile tedavi edilen hastalarımızın cerrahi, onkolojik ve fonksiyonel sonuçları güncel literatür ile uyumlu olup prostat kanseri tanılı cerrahiye uygun hastalar için etkili ve güvenilir bir tedavi seçeneğidir

Anahtar Kelimeler

• Laparoskopi, Prostat kanseri, Radikal prostatektomi

The Evaluation of Surgical, Oncologic and Functional Results After Laparoscopic Radical Prostatechtomy

Abstract

Objective: The aim of this study is to present the surgical outcomes of the first 140 cases of laparoscopic radical prostatectomy operations due to prostate cancer performed at the urology department of Akdeniz University Faculty of Medicine between 2004 and 2007 and the oncological and functional results of 88 cases after 24 months of follow-up.Material and Methods: Between October 2004 and August 2007, 140 patients with clinically localized prostate cancer were treated with laparoscopic radical prostatectomy. Details of the operations were recorded. Follow-up PSA values, continence status and erection quality of 88 patients were obtained at postoperative 3, 6, 9, 12, 18 and 24 months.Results: Median values of the mean operation and the uretro-vesical anastomosis times of our cases were 225 and 30 minutes, respectively. Median values of the mean urethral catheterization and hospitalization times were 8 and 4 days. When the results of the patients were evaluated according to the histopathological examinations, the rates of surgical margin positivity with prognostic significance were obtained as 6.0% and 40.9% in pT2 and pT3 cases, respectively. Functionally, the complete continence rate within the first 3 months following urethral catheter removal was 69.2%, while the full continence rate at 18 months reached 90%. Successful erection rates were achieved in 68.2 % of the patients with the bilateral nerve-sparing approach. Conclusion: The surgical, oncological and functional outcomes of our first 140 patients treated with laparoscopic radical prostatectomy are in accordance with the current literature, supporting this method as an effective and safe option for appropriate patients with prostate cancer

Keywords

• Laparoscopy, Prostate cancer, Radical prostatectomy

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