Yüksek riskli prostat kanserli hastalarda açık retropubik ve robot yardımlı radikal prostatektominin onkolojik ve fonksiyonel sonuçları

Year 2021, Volume: 13 Issue: 2, 38 - 46, 31.07.2021

Furkan Şendoğan , Volkan Tuğcu , Turgay Turan , Selçuk Şahin , Özgür Efiloğlu , Asıf Yıldırım

Abstract

Amaç: Çalışmamızda yüksek riskli prostat kanserine sahip hastalarda uygulanan açık ve robot yardımlı prostatektominin onkolojik ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışmamızda deneyimli iki merkez tarafından 2014-2018 yılları arasında 118 açık radikal prostatektomi (ORP) ve 66 robot-yardımlı radikal prostatektomi (RARP) uygulanan yüksek risk prostat kanserine sahip hastaların dataları retrospektif olarak değerlendirilmiştir. D’Amico risk sınıflamasına göre prostat spesifik antijen (PSA)>20 ng/ml veya Gleason skor >7 (ISUP-grade 4/5) veya klinik evre ≥ T2c komponentlerinden herhangi birine sahip hastalar yüksek riskli prostat kanseri olarak kabul edilmiştir. Hastalara operasyon öncesi uzak metastazı dışlamak ve ekstrakapsüler yayılım riskini değerlendirmek amacıyla tüm abdomen manyetik rezonans görüntüleme (MRG) ve kemik sintigrafisi gerçekleştirilmiştir. Hastaların iki defa ardışık olarak değerlendirilen PSA değerinin ≥ 0.2 ng/mL olması biyokimyasal rekürrens olarak kabul edilmiştir. Üriner kontinans ped kullanım durumu ile erektil fonksiyon ise fosfodiesteraz tip-5 inhibitörü kullanımı ile veya kullanılmadan gerçekleştirilen vajinal penetrasyonun sözel sorgulanması ile tanımlanmıştır.
Bulgular: Çalışmamızda preoperatif PSA değeri, prostat biyopsi Uluslararası Ürolojik Patoloji Topluluğu (ISUP) derecesi ve klinik evre ORP grubunda istatistiksel anlamlı düzeyde daha yüksek saptanmıştır. Her iki grup arasında pozitif cerrahi sınır, ekstrakapsüler yayılım, seminal vezikül invazyonu ve lenf nod invazyonu açısından anlamlı bir fark saptanmamıştır. Biyokimyasal rekürrens ORP grubunda daha yüksek saptanmış olup androjen deprivasyon tedavisi ve radyoterapi gibi adjuvan tedaviler açısından her iki grup arasında anlamlı bir fark saptanmamıştır. Her iki grupta hastaların birinci yıl değerlendirmelerinde üriner inkontinans ve erektil disfonksiyon açısında anlamlı bir fark bulunmamıştır. Ortalama takip süresi RARP ve ORP için sırasıyla 15,55 ve 46,45 aydır.
Sonuç: Yüksek riskli prostat kanserinde uygulanan açık ve robot yardımlı prostatektomi onkolojik ve fonksiyonel olarak benzer sonuçlara sahiptir.

Keywords

Radikal prostatektomi, Robot-yardımlı radikal prostatektomi, Yüksek riskli prostat kanseri, Açık retropubik radikal prostatektomi

Supporting Institution

Yok

Project Number

Yok

Oncologic and functional outcomes of open retropubic vs robot-assisted radical prostatectomy in patients with high risk prostate cancer

Abstract

Objective: The aim of this study is to evaluate oncological and functional outcomes of open radical prostatectomy (ORP) and robot-assisted prostatectomy (RARP) in patients with high-risk prostate cancer.
Material and Methods: In our study, patients with high-risk prostate cancer who underwent 118 ORP and 66 RARP between 2014-2018 have been evaluated retrospectively. Patients with prostate specific antigen (PSA)>20 ng/ml or Gleason score >7 or clinical stage ≥T2c according to D’Amico risk classifications are considered to high-risk prostate cancer. Preoperative abdominal magnetic resonance imaging (MRI) and bone scintigraphy were performed in each patient to assess the risk of extracapsular extension and exclude metastasis. The PSA value of 0.2 ng/mL in patients following two consecutive evaluations is accepted as biochemical recurrence. Urinary continence with pad use and erectile function were evaluated by verbal questioning of vaginal penetration performed with or without the use of phosphodiesterase type-5 inhibitors.
Results: In our study; preoperative PSA values, prostate biopsy ISUP grade, and clinical stage were found significantly higher in the ORP group. There was no significant difference between the groups in terms of positive surgical margin, extracapsular extension, seminal vesicle, and lymph node invasion. Biochemical recurrence was higher in the ORP group but there was no significant difference between the groups in terms of adjuvant treatments such as radiotherapy and androgen deprivation therapy. And there was no significant difference in urinary incontinence and erectile dysfunction in the first-year assessments of patients. Median follow-up was 15.55 and 46.45 months for RARP and ORP, respectively.
Conclusion: ORP and RARP have similar oncological and functional outcomes in high-risk prostate cancer. 

Keywords

Robot-assisted radical prostatectomy, high risk prostate cancer, open retropubic radical prostatectomy

Project Number

Yok

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