Açık cerrahiden laparoskopik radikal prostatektomiye geçiş: Öğrenme eğrisi sürecinde güvenlik ve uygulanabilirlik

Öz

Amaç: Bu çalışma, uzun yıllardır açık retropubik radikal prostatektomi (RRP) deneyimine sahip bir merkezde açık cerrahiden laparoskopik radikal prostatektomiye (LRP) geçiş sırasında karşılaşılan zorlukları analiz etmeyi ve erken öğrenme eğrisi döneminde perioperatif, onkolojik ve fonksiyonel sonuçları değerlendirmeyi amaçladı. Gereç ve Yöntemler: Ocak–Haziran 2025 tarihleri arasında radikal prostatektomi uygulanan 12 LRP ve 21 RRP hastası prospektif olarak kaydedildi ve retrospektif olarak analiz edildi. Perioperatif parametreler, patolojik sonuçlar ve fonksiyonel bulgular incelendi. Kontinans, ICIQ-SF skorları kullanılarak değerlendirildi ve skor ≤5 olması veya tamamen ped kullanılmaması kontinans olarak tanımlandı. Potens, IIEF-5 skorları ile değerlendirildi ve skorun ≥17 olması potens olarak kabul edildi. Komplikasyonlar Satava ve Clavien-Dindo sınıflama sistemlerine göre değerlendirildi. Bulgular: Başlangıç demografik ve klinikopatolojik özellikler benzerdi. LRP grubunda tahmini kan kaybı anlamlı olarak daha düşük (660.5±221.4’e karşı 1100±528.1 mL, p=0.021), transfüzyon oranı daha az (%25.0’a karşı %71.4, p=0.027), dren çekilme süresi daha kısa (medyan 2’ye karşı 4 gün, p=0.002) ve hastanede kalış süresi daha kısa bulundu (medyan 3’e karşı 4 gün, p=0.006). Perioperatif komplikasyon oranları benzerdi (%16,7’ye karşı %9,5, p=0,708). Pozitif cerrahi sınır oranları (%33.3’e karşı %66.7, p=0.137) ve biyokimyasal nüks oranları (%8.3’e karşı %4.8, p=0.685) dahil olmak üzere patolojik sonuçlar açısından anlamlı fark saptanmadı. LRP grubunda 1. ayda erken kontinans oranı anlamlı derecede daha yüksek bulundu (%33,3’e karşı %4.8, p=0,029). Ayrıca 3. ayda (10.5’e karşı 8, p=0.020) ve 6. ayda (13.5’e karşı 9, p=0.030) IIEF-5 skorları daha yüksek saptandı. Sonuç: LRP, öğrenme eğrisi sürecinde erken onkolojik veya fonksiyonel sonuçlardan ödün vermeden güvenle uygulanabilir.

Anahtar Kelimeler

• Laparoskopik radikal prostatektomi
• retropubik radikal prostatektomi
• öğrenme eğrisi
• prostat kanseri

Destekleyen Kurum

yok

Etik Beyan

Çalışma protokolü, Zonguldak Bülent Ecevit Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylandı (onay numarası: 2025/20-16) ve Helsinki Deklarasyonu ilkelerine uygun olarak yürütüldü.

Teşekkür

yok

Transitioning from open to laparoscopic radical prostatectomy: Safety and feasibility during the learning curve

Öz

Aim: This study aimed to analyze the challenges encountered during the transition from open retropubic radical prostatectomy (RRP) to laparoscopic radical prostatectomy (LRP) at a long-standing center of open RRP experience and to evaluate surgical, tumor-related, and functional outcomes during the adaptation period. Material and Methods: 12 LRP and 21 RRP patients operated between January-June 2025 were prospectively collected and retrospectively analyzed. Perioperative parameters, pathological outcomes, and functional results were analyzed. Continence was assessed using ICIQ-SF scores and defined as score ≤5 or complete absence of pad use. Potency was evaluated using IIEF-5 scores, with potency defined as score ≥17. Complications were stratified according to Satava and Clavien-Dindo systems. Results: Baseline demographic and clinicopathological characteristics were comparable. The LRP group demonstrated significantly reduced estimated blood loss (660.5±221.4 vs 1100±528.1 mL, p=0.021), lower transfusion rate (25.0% vs 71.4%, p=0.027), shorter drain removal time (median 2 vs 4 days, p=0.002), and reduced length of hospital stay (median 3 vs 4 days, p=0.006). Perioperative complications were similar (16.7% vs 9.5%, p=0.708). Positive surgical margin rates (33.3% vs 66.7%, p=0.137) and biochemical recurrence rates (8.3% vs 4.8%, p=0.685), showed no significant differences. The LRP group achieved significantly higher early continence at 1st month (33.3% vs 4.8%, p=0.029) and higher IIEF-5 scores at 3rd (10.5 vs 8, p=0.020) and 6th months (13.5 vs 9, p=0.030). Conclusion: LRP can be safely adopted during the learning curve without compromising early oncological or functional outcomes.

Anahtar Kelimeler

• Laparoscopic radical prostatectomy
• retropubic radical prostatectomy
• learning curve
• prostate cancer

Destekleyen Kurum

N/A

Etik Beyan

The study protocol was approved by the Clinical Research Ethics Committee of Zonguldak Bülent Ecevit University (approval number: 2025/20-16) and complied with the tenets of the Helsinki Declaration.

Teşekkür

N/A

Kaynakça

1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. https://doi.org/10.3322/caac.21834
2. European Association of Urology. EAU Guidelines on Prostate Cancer. 2025. Available at: https://uroweb.org/guidelines/prostate-cancer
3. Young HH. VIII. Conservative perineal prostatectomy: The results of two years' experience and report of seventy-five cases. Ann Surg. 1905;41(4):549-557.
4. Millin T. Retropubic prostatectomy. J Urol. 1948;59(3):267-280. https://doi.org/10.1016/S0022-5347(17)69374-1
5. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: Initial short-term experience. Urology. 1997;50(6):854-857. https://doi.org/10.1016/S0090-4295(97)00543-8
6. Abbou CC, Salomon L, Hoznek A, Antiphon P, Cicco A, Saint F, et al. Laparoscopic radical prostatectomy: preliminary results. Urology. 2000;55(5):630-644. https://doi.org/10.1016/S0090-4295(00)00502-1
7. Jacob F, Salomon L, Hoznek A, Bellot J, Antiphon P, Chopin DK, et al. Laparoscopic radical prostatectomy: preliminary results. Eur Urol. 2000;37(5):615-620. https://doi.org/10.1159/000020202
8. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int. 2001;87(4):408-410. https://doi.org/10.1046/j.1464-410x.2001.00115.x

9. Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev. 2017;9(9):CD009625. https://doi.org/10.1002/14651858.CD009625.pub2
10. Dell'Oglio P, Mottrie A, Mazzone E. Robot-assisted radical prostatectomy vs. open radical prostatectomy: latest evidences on perioperative, functional and oncological outcomes. Curr Opin Urol. 2020;30(1):73-78. https://doi.org/10.1097/MOU.0000000000000688
11. Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388(10049):1057-1066. https://doi.org/10.1016/S0140-6736(16)30592-X
12. Ramsay C, Pickard R, Robertson C, Close A, Vale L, Armstrong N, et al. Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technol Assess. 2012;16(41):1-313. https://doi.org/10.3310/hta16410
13. Wang J, Hu K, Wang Y, Wu Y, Bao E, Wang J, et al. Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Surg. 2023;17(6):2617-2631. https://doi.org/10.1007/s11701-023-01714-8
14. Wang CJ, Chen CX, Liu Y, Wen Z, Li HY, Huang HT, et al. Comparative analysis of perioperative outcomes in obese patients undergoing robot-assisted radical prostatectomy (RARP) versus open radical prostatectomy (ORP): a systematic review and meta-analysis. J Robot Surg. 2024;18(1):248. https://doi.org/10.1007/s11701-024-02010-9
15. Carbonara U, Srinath M, Crocerossa F, Ferro M, Cantiello F, Lucarelli G, et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes. World J Urol. 2021;39(10):3721-3732. https://doi.org/10.1007/s00345-021-03687-5
16. Wang K, Zhuang Q, Xu R, Lu H, Song G, Wang J, et al. Transperitoneal versus extraperitoneal approach in laparoscopic radical prostatectomy: A meta-analysis. Medicine (Baltimore). 2018;97(29):e11176. https://doi.org/10.1097/MD.0000000000011176
17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
18. Satava RM. Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol. 2005;14(4):257-261. https://doi.org/10.1080/13645700500274112
19. Vickers AJ, Savage CJ, Hruza M, Tuerk I, Koenig P, Martínez-Piñeiro L, et al. The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study. Lancet Oncol. 2009;10(5):475-480. https://doi.org/10.1016/S1470-2045(09)70079-8
20. Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV. Technique for laparoscopic running urethrovesical anastomosis:the single knot method. Urology. 2003;61(4):699-702. https://doi.org/10.1016/S0090-4295(02)02543-8
21. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009;55(5):1037-1063. https://doi.org/10.1016/j.eururo.2009.01.036
22. Secin FP, Savage C, Abbou C, de La Taille A, Salomon L, Rassweiler J, et al. The learning curve for laparoscopic radical prostatectomy: an international multicenter study. J Urol. 2010;184(6):2291-2296. https://doi.org/10.1016/j.juro.2010.08.003
23. Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, Menon M, Mottrie A, Myers RP, Patel V, Tewari A, Villers A, Artibani W. A Critical Analysis of the Current Knowledge of Surgical Anatomy of the Prostate Related to Optimisation of Cancer Control and Preservation of Continence and Erection in Candidates for Radical Prostatectomy: An Update. Eur Urol 2016;70:301-311.https://doi.org/10.1016/j.eururo.2016.01.026
24. Good DW, Stewart GD, Stolzenburg JU, McNeill SA. Analysis of the pentafecta learning curve for laparoscopic radical prostatectomy. World J Urol. 2014;32(5):1225-1233. https://doi.org/10.1007/s00345-013-1198-9