Kombine Açık Radikal Prostatektomi: Fonksiyonel ve Onkolojik Değerlendirme

Yıl 2020, Cilt: 7 Sayı: 2, 70 - 75, 31.08.2020

İlker Akarken , Hüseyin Tarhan , Ömer Erdoğan , Mustafa Kestel , Hasan Deliktaş , Mehmet Çetinkaya Yelda Morgül Dere , Hayrettin Şahin

Öz

Prostat kanseri erkeklerde en sık tanı konulan kanser türlerinden biridir. Prostat spesifik antijen (PSA) taramasıyla birlikte hastalar daha erken dönemde tanı almakta ve daha fazla sayıda hasta radikal prostatektomi (RP) operasyonu geçirmektedir. RP açık, laparoskopik ve robot yardımlı teknikler ile uygulanabilmektedir. Ayrıca açık RP için retrograd ve antegrad teknikler tarif edilmiştir. Biz kliniğimizde her iki tekniğin karşımı olan kombine tekniği uygulamaktayız. Bu çalışmada kombine açık RP tekniğinin onkolojik ve fonksiyonel sonuçlara etkisi araştırıldı. 2012-2018 yılları arasında kombine RP uygulanan 89 hastanın verileri retrospektif olarak değerlendirildi. Kombine teknikte hastaların tümüne denonviller fasyasına kadar retrograde yöntem uygulanırken, bu aşamadan sonra antegrad yöntem uygulandı. 12 aylık takip sonunda idrar kaçırması olmayan hastalar kontinan kabul edildi. Erektil fonksiyon uluslararası erektil fonksiyon indeksine göre değerlendirildi; bu değer 19’un üzerinde ise hastalar potent kabul edildi. Ortalama operasyon süresi 125.4±15dk, per-op kan kaybı 350±50ml olarak saptandı. Operasyon sonrasında ortalama hastanede yatış süresi 7±2 gün bulundu. Hastalar ortalama 18,5 ay takip edildi. Takip süresince sadece 1 (%1) hasta kardiyak nedenle ex oldu ve 23 (%25) hastada PSA nüksü saptandı. Hastaların takiplerinde 24 (%27) hastada erektil disfonksiyon saptanırken, 26 (%29) hastada üriner inkontinans saptandı. Kombine RP’nin diğer yöntemlerle benzer onkolojik ve fonksiyonel sonuçları olduğu ortaya konulmuştur.

Anahtar Kelimeler

Açık Radikal Prostatektomi, Kombine Teknik, Prostat Kanseri

Combined Open Radical Prostatectomy: Functional and Oncologic Assessment

Öz

Prostate cancer is one of the most common malignancies in males. Since the widespread use of prostate specific antigen (PSA) screening, more patients are diagnosed at early stages of the disease and subsequently underwent radical prostatectomy (RP). RP may be performed via open, laparoscopic or robot assisted laparoscopic techniques. Open RP may be performed in an antegrade or retrograde fashion. In this study, we assessed the oncologic and functional effects of combined retrograde and antegrade open RP technique. The data of 89 patients, who underwent combined RP between 2012 to 2018, were assessed retrospectively. The combined technique is performed retrograde way until to the Denonvilliers' fascia dissection and advanced with antegrade way in the rest of the operation. Urinary continence and erectile functions were assessed after 12 months follow-up. Erectile functions were assessed with International Index of Erectile Function (IIEF). Patients with IIEF scores >19 were considered as potent. Mean operation time, blood loss and hospital stay were 125.4±15min and 350±50ml, 7±2 days, respectively. In mean 18.5 months of follow-up, only 1 (1%) of the patients were died due to a cardiac event and 23 (25%) had PSA recurrence. Erectile disfunction and urinary incontinence were detected in 24 (27%) and 26 (29%) patients, respectively. The combined RP technique has similar oncologic and functional results with other techniques.

Anahtar Kelimeler

Combined Technique, Open Radical Prostatectomy, Prostate Cancer

Kaynakça

• Meng M V, Elkin Ep, Harlan Sr, Mehta Ss, Lubeck Dp, Carroll Pr. Predictors of Treatment After Initial Surveillance in Men With Prostate Cancer: Results From CaPSURE. J Urol. 2003;170:2279–83.
• Özden E, Bostancı Y, Yakupoğlu YK. Lokalize prostat kanseri küratif tedavisinde cerrahi tedavi seçeneklerinin kritik analizi: açık, laparoskopik, robotik radikal prostatektomi. Üroonkoloji Bült. 2011:47–50.
• Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet (London, England.) 2016;388:1057–66.
• Allan C, Ilic D. Laparoscopic versus Robotic-Assisted Radical Prostatectomy for the Treatment of Localised Prostate Cancer: A Systematic Review. Urol Int. 2015;96:373–8.
• Walsh PC. Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate. J Urol. 2000;163:1802–7.
• Carini M, Masieri L, Minervini A, Lapini A, Serni S. Oncological and Functional Results of Antegrade Radical Retropubic Prostatectomy for the Treatment of Clinically Localised Prostate Cancer. Eur Urol. 2008;53:554–63.
• Reiner WG, Walsh PC. An anatomical approach to the surgical management of the dorsal vein and Santorini’s plexus during radical retropubic surgery. J Urol. 1979;121:198–200.
• Campbell EW. Total prostatectomy with preliminary ligation of the vascular pedicles. Trans Am Assoc Genitourin Surg. 1958;50:12-5; discussion 16-8.
• Mittemeyer BT, Cox HD. Modified radical retropubic prostatectomy. Urology. 1978;12:313–20.
• Touijer K, Guillonneau B. Laparoscopic Radical Prostatectomy: A Critical Analysis of Surgical Quality. Eur Urol. 2006;49:625–32.
• Chang SS, Duong DT, Wells N, Cole EE, Smith JA, Cookson MS. Predicting blood loss and transfusion requirements during radical prostatectomy: the significant negative impact of increasing body mass index. J Urol. 2004;171:1861–5.
• Kyei MY, Mensah EJ, Gepi-Attee S, et al. Outcomes after Radical Prostatectomy in Ghanaians: A Surgeon’s Early Experience. ISRN Urol. 2013;2013:1–5.
• Morrison BF, Coard K, Strachan G, Miller R, Aiken W, Mayhew R. Radical prostatectomy outcomes at the University Hospital of the West Indies: 2000-2007. West Indian Med J. 2011;60:68–72.
• Faydacı G, Kuyumcuoğlu U. Radikal prostatektomi teknikleri arasında üroonkolojik sonuçlar açısından fark var mı? Üroonkoloji Bült. 2010:37–40.
• Ahlering TE. Robotic versus laparoscopic radical prostatectomy. Nat Clin Pract Urol. 2004;1:58–9.
• Chuang A-Y, Nielsen ME, Hernandez DJ, Walsh PC, Epstein JI. The Significance of Positive Surgical Margin in Areas of Capsular Incision in Otherwise Organ Confined Disease at Radical Prostatectomy. J Urol. 2007;178:1306–10.
• Smith JA, Chan RC, Chang SS, et al. A Comparison of the Incidence and Location of Positive Surgical Margins in Robotic Assisted Laparoscopic Radical Prostatectomy and Open Retropubic Radical Prostatectomy. J Urol. 2007;178:2385–90. Coelho RF, Rocco B, Patel MB, et al. Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers. J Endourol. 2010;24:2003–15.
• Chun FK-H, Graefen M, Zacharias M, et al. Anatomic radical retropubic prostatectomy—long-term recurrence-free survival rates for localized prostate cancer. World J Urol. 2006;24:273–80.
• Han M, Partin AW, Zahurak M, Piantadosi S, Epstein JI, Walsh PC. Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol. 2003;169:517–23.
• Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT. Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol. 2002;167:528–34.
• Eckersberger E, Finkelstein J, Sadri H, et al. Screening for Prostate Cancer: A Review of the ERSPC and PLCO Trials. Rev Urol. 2009;11:127–33.
• Touijer K, Secin FP, Cronin AM, Katz D, Bianco F, Vora K, et al. Oncologic Outcome after Laparoscopic Radical Prostatectomy: 10 Years of Experience. Eur Urol. 2009;55:1014–9.
• Mohamad Al-Ali B, Ponholzer A, Augustin H, Madersbacher S, Pummer K. The Long-Term Effect of Radical Prostatectomy on Erectile Function, Urinary Continence, and Lower Urinary Tract Symptoms: A Comparison to Age-Matched Healthy Controls. Biomed Res Int. 2017;2017:1–5.
• Novara G, Ficarra V, Rosen RC, et al. Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy. Eur Urol. 2012;62:431–52.
• Drouin SJ, Vaessen C, Hupertan V, et al. Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer. World J Urol. 2009;27:599–605.
• Kundu SD, Roehl KA, Eggener SE, Antenor JA V, Han M, Catalona WJ. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol. 2004;172:2227–31.
• Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA.2000;283:354–60.