经腹腔镜和腹膜外腹腔镜根治性前列腺切除术围手术期、功能和肿瘤结果的比较。

IF 1.3 Q3 SURGERY
Minimally Invasive Surgery Pub Date : 2023-02-07 eCollection Date: 2023-01-01 DOI:10.1155/2023/3263286
Tanan Bejrananda, Watid Karnjanawanichkul, Monthira Tanthanuch
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引用次数: 0

摘要

目的:本研究旨在比较采用腹膜内或腹膜外腹腔镜前列腺癌根治术(LRP)治疗局部和局部晚期前列腺癌的肿瘤、功能和围手术期疗效:从2008年4月到2020年12月,266名患者接受了腹腔镜前列腺癌根治术,其中168例采用腹膜外方法(E-LRP),98例采用经腹膜方法(T-LRP)。研究人员收集了这两组患者的临床、围手术期、功能和肿瘤学结果,并进行了比较。在 3 个月、12 个月和 24 个月的随访中,测试的功能结果是排尿功能(EPIC 的排尿领域)和性功能(EPIC 的性功能领域)。对生化复发、无生化复发生存期和手术切缘阳性状态等肿瘤学结果进行了评估。单变量和多变量 Cox 回归分析用于确定预测生化复发的因素。所有统计分析均使用 R 程序:除了T-LRP组的前列腺特异性抗原(PSA)较高外,E-LRP组和T-LRP组的患者特征相似。与 E-LRP 相比,T-LRP 的总手术时间更短(222.5 分钟对 290 分钟,P 0.001),失血量更少(400 毫升对 800 毫升,P < 0.001),住院时间更短(4 天对 7 天,P < 0.001)。T-LRP组在3个月后的早期性交和插入率更高(36.7% 对 15.5%,P 0.001)。术后3个月和24个月时,T-LRP组和E-LRP组的尿失禁率(无尿垫)没有差异,但术后12个月时,E-LRP组的尿失禁率更高(分别为1% vs. 3%; p=0.419, 85.1 vs. 83.7%; p=0.889, 47.4% vs. 34.6%; p=0.028)。EPIC问卷用于评估术后3、12和24个月的功能预后,结果发现T-LRP组的排尿功能在3和12个月时显著较高(P<0.001),但在24个月时没有差异(P=0.734),T-LRP组的性功能评分在12和24个月时较高(P=0.001)。E-LRP 组的手术切缘阳性率更高(38.7% 对 21.4%;P=0.006)。两组的 BCR 率没有差异(E-LRP 组为 36.3%,E-LRP 组为 27.6%;P=0.184):结论:经腹膜腹腔镜前列腺癌根治术(T-LRP)在围术期结果方面优于腹膜外前列腺癌根治术(E-LRP),如缩短手术时间、减少失血量、缩短住院时间、降低手术切缘阳性率、改善早期性交和性功能。T-LRP组在3个月和12个月后的泌尿功能结果更好。这些研究结果支持使用经腹腔镜前列腺癌根治术,因为我们的研究对象从该手术中获益良多。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Comparison of Perioperative, Functional, and Oncological Outcomes of Transperitoneal and Extraperitoneal Laparoscopic Radical Prostatectomy.

Comparison of Perioperative, Functional, and Oncological Outcomes of Transperitoneal and Extraperitoneal Laparoscopic Radical Prostatectomy.

Purpose: This study aimed to compare the oncological, functional, and perioperative outcomes of localized and locally advanced prostate cancer treated with intraperitoneal or extraperitoneal laparoscopic radical prostatectomy (LRP).

Methods: From April, 2008, through December, 2020, 266 patients underwent laparoscopic radical prostatectomy, 168 cases with an extraperitoneal approach (E-LRP) and 98 cases using a transperitoneal approach (T-LRP). The clinical, perioperative, functional, and oncological outcomes were collected and compared between these groups. At the 3-, 12- and 24-monthfollow-ups, the functional outcomes tested were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC). The oncological outcomes of biochemical recurrence, biochemical recurrence-free survival, and positive surgical margin status were evaluated. Univariable and multivariable Cox regression analyses were used to identify factors predictive for biochemical recurrence. All statistical analyses used the R program.

Results: The patient characteristics were similar between the E-LRP and T-LRP groups except for higher prostatic-specific antigen (PSA) in the T-LRP group. The T-LRP had lower overall operative time (222.5 min vs. 290 min, p 0.001), decreased blood loss (400 ml vs. 800 ml, p < 0.001), and shorter hospital stays (4 days vs. 7 days, p < 0.001) compared to the E-LRP. Early sexual intercourse with penetration at 3 months was higher in the T-LRP group (36.7% vs. 15.5%, p 0.001). Urinary continence (no pads) was not different between the T-LRP and E-LRP groups at 3 and 24 months after surgery but higher in the E-LRP group at 12 months (1% vs. 3%; p=0.419, 85.1 vs. 83.7%; p=0.889, 47.4% vs. 34.6%; p=0.028, respectively). The EPIC questionnaire was used to assess functional outcomes at 3, 12, and 24 months after surgery and found that urinary function was significantly higher in the T-LRP group at 3 and 12 months (p < 0.001) but did not show a difference at 24 months (p=0.734), and sexual function scores were higher in the T-LRP group at 12 and 24 months (p=0.001). The positive surgical margin rate was higher in the E-LRP (38.7% vs. 21.4%; p=0.006). The BCR rate was not different between the groups (36.3% in the E-LRP group and 27.6% in the E-LRP group; p=0.184).

Conclusion: Transperitoneal laparoscopic radical prostatectomy (T-LRP) was found to be superior to extraperitoneal radical prostatectomy (E-LRP) in perioperative outcomes such as decreased operative time, decreased blood loss, shorter hospital stay, lower positive surgical margin, and improved early sexual intercourse and sexual function. The urinary functional outcome was better in the T-LRP group at 3 and 12 months. These findings support the use of transperitoneal laparoscopic radical prostatectomy, as our study patients exhibited significant benefits from this procedure.

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