Sakarya Üniversitesi’nde Robot Yardımlı Laparoskopik Radikal Prostatektomi: Başlangıç Deneyimlerimiz

Year 2018, Volume: 8 Issue: 1, 134 - 140, 26.03.2018

Hacı İbrahim Çimen , Hacı Can Direk Fikret Halis Osman Köse Ahmet Gökçe Hasan Salih Sağlam

https://doi.org/10.31832/smj.397942

Abstract

Amaç: Robot yardımlı laparoskopik radikal
prostatektomi (RYLRP) sonuçlarımızı sunmak.

Yöntem: Şubat 2015 – Aralık 2017 yılları arasında lokalize
prostat kanseri (PCa) nedeniyle Sakary Üniversitesi’nde RYLRP operasyonu
uygulanan  hastaların sonuçları
retrospektif olarak değerlendirildi.

Bulgular: Hastaların
ortalama takip süreleri 16.1 (1-36) ay olarak bulundu. Hastaların ortalama
yaşı 64.04 ± 6.33 yıl olarak saptandı. D’Amico risk sınıflamasına
göre hastaların 29’u (%60.4) düşük risk, 
13’ü (%27.1) orta risk ve 6’sı (%12.5) yüksek risk sınıfında saptandı. Ortalama
operasyon süresi 237.7 ± 48.07 dk, ortalama
tahmini kan kaybı 190.4 ± 65.8 ml olarak bulundu.
Ortalama dren çekilme süresi 3.93 ± 1.81 gün, ortalama hastanede kalış süresi
4.66 ± 1.91 gün, ortalama sonda çekilme süresi 14.1 ± 2.1 gün olarak bulundu.
On (%20,8) hastada cerrahi sınır pozitif saptandı. Kontinans oranları
postoperatif 1. ay, 6. ay ve 12. ay’da sırasıyla %50, %71.4 ve %85.2 olarak
bulundu. Potens oranları postoperatif 1. ay, 6. ay ve 12. ay’da sırasıyla
%37.5, %42.9 ve %51.2 olarak tespit edildi. Takiplerde 1 hastada biyokimyasal  nüks tespit edildi.

Sonuç: RYLRP lokalize PCa’nin
tedavisinde etkin ve güvenilir bir yöntemdir. Sonuçlarımız literatürle
uyumludur. Cerrahi tecrübe arttıkça daha iyi onkolojik ve fonksiyonel sonuçlar
alınacaktır.

Anahtar
kelime: Öğrenme eğrisi, prostat kanseri, robotik
cerrahi.    

Keywords

Öğrenme eğrisi, prostat kanseri

Robot Assisted Laparoscopic Radical Prostatectomy In Sakarya University: Our Initial Experience

Abstract

Objective: To present our robot assisted laparoscopic
radical prosatatectomy (RALRP) results.

Method: The results of patients who underwent RALRP
between February 2015 and December 2017 for localized prostate cancer (PCa) at
Sakarya University were retrospectively evaluated.

Results: Mean follow-up time was 16.1 (1-36) months.
The mean patient age was 64.04 ± 6.33 years. According to D’Amico risk
classification; 29 (60.4%) patients were found to have low risk, 13  (27.1%) patients have moderate risk and 6
(12.5%) patients have high risk. Mean operation time was 237.7 ± 48.07 min, mean estimated blood loss was 190.4 ± 65.8 ml. Mean draining time was 3.93 ± 1.81 days, mean
hospitalization time was 4.66 ± 1.91 days and mean catheterization time was 14.1
± 2.1 days. Surgical margin positivity was found in 10 (20.8%) patients. The
continent rate at postoperative 1th, 6th and 12th months were 50%, 71.4% and
85.2%; respectively. The potency rates at postoperative 1th, 6th and 12th
months were 37.5%, 42.9% and 51.2%; respectively. Biochemical recurrence was
detected in 1 patient at follow-up period.

Conclusion: RALRP is an effective and reliable method for localized PCa
treatment. Our results are consistent with the literature. Better oncologic and
functional results will be obtained as surgical experience increases.

Keywords

Lurning curve, prostate cancer

References

• 1.Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017; 67(1): 2. Schröder FH, Carter HB, Wolters T, van den Berg RC, Gosselaar C, Bangma CH et al. Early detection of prostate cancer in 2007. Part 1: PSA and PSA kinetics. Eur Urol 2008; 53(3): 468-77. 3. Walsh PC. Anatomic Radical Retropubic Prostatectomy; in Walsh PC, Retik AB, Vaughan ED, Wein AJ(Eds.): Campbell’s Urology 7th Edition, 1998: 2565-88.4. Bianco FJ Jr, Scardino PT, Eastham JA. Radical prostatectomy: longterm cancer control and recovery of sexual and urinary function (“trifecta”). Urology 2005; 66: 83-94. [CrossRef]5. Binder J, Brautigam R, Jonas D, Bentas W. Robotic surgery in urology: fact or fantasy BJU international 2004;94:1183-1187.6. Hu JC, Gu X, Lipsitz SR, Barry MJ, D’Amico AV, Weinberg AC et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 2009;302:1557-1564.7. Duffey B, Varda B, Konety B. Quality of evidence to compare outcomes of open and robot-assisted laparoscopic prostatectomy. Current urology reports 2011;12:229-236.8. Kang DC, Hardee MJ, Fesperman SF, Stoffs TL, Dahm P. Low quality of evidence for robot-assisted laparoscopic prostatectomy: results of a systematic review of the published literature. European urology2010;57:930-937.9. Lowrance WT, Tarin TV, Shariat SF. Evidence-based comparison of robotic and open radical prostatectomy. TheScientificWorldJournal. 2010;10:2228-223710. Cooperberg MR, Pasta DJ, Elkin EP, Litwin MS, Latini DM, Du Chane J et al. The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. J Urol 2005, 173(6): 1938-42.11. Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. 2013 Jan;111(1):22-9. doi: 10.1111/j.1464-410X.2012.11324.x. Epub 2012 Jul 26.12. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattiku Urology Institute experience. Urology 2002; 60(5):864-8.13. Fracalanza S, Ficarra V, Cavalleri S, Galfano A, Novara G, Mangano A, et al. Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study. BJU Int 2008; 101(9):1145-9.14. Farnham SB, Webster TM, Herrell SD, Smith JA Jr. Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy. Urology 2006;67:360–3.15. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M et al. Retropubik, laparoskopik and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 2009; 55:1037-63.16. Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody JO et al. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 2002;168:945–9.17. Joseph JV, Vicente I, Madeb R, Erturk E, Patel HR. Robot- assisted versus pure laparoscopic radical prostatectomy: are there any differences? BJU Int 2005;96:39–42. 18. Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M et al. Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Eur Urol 2007; 51(3):648-57.19. Mottrie A, Van Migem P, De Naeyer G, Schatteman P, Carpentier P, Fonteyne E. Robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of 184 cases. Eur Urol 2007; 2:746-51.20. Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int 2007; 99:1109-12.21. Kural AR, Atuğ F. The applications of robotic surgery in urology. Turkish Journal of Urology 2010; 36: 248-57. [CrossRef]22. Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Zagaja GP, Shalhav AL. Robotic- assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. Eur Urol 2007; 51: 755-63. 23. Ahlering TE, Wood D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology 2004b;63:819–22.24. Menon M, Muhletaler F, Campos M, Peabody JO. Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a 2 group parallel randomized controlled trial. J Urol 2008;180:1018–23.25. Tewari AK, Bigelow K, Rao S, Takenaka A, El-Tabi N, Te A et al. Anatomic restoration technique of continence mechanism and preservation of puboprostatic collar: a novel modification to achieve early urinary continence in men undergoing robotic prostatectomy. Urology 2007;69:726–31. 26. Krambeck AE, DiMarco DS, Rangel LJ, Bergstralh EJ, Myers RP, Blute ML et al. Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int 2009;103:448–52.27. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982;128:492–7.28. Menon M, Tewari A, Peabody J, Shrivastava A, Kaul S, Bhandari A et al. Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am 2004; 31: 701-7.29. Cathelineau X, Rozet F, Vallancien G. Robotic radical prostatectomy: the European experience. Urol Clin North Am; 31: 693-9.