根治性前列腺切除术治疗局部晚期前列腺癌的临床观察

S. Popov, R. Guseynov, I. Orlov, K. V. Sivak, O. Skryabin, V. V. Perepelitsa, A. Katunin, S. Yasheva, A. S. Zaytsev
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引用次数: 0

摘要

背景。根治性前列腺切除术治疗局部晚期前列腺癌目前被推荐为多模式治疗的阶段之一。尽管如此,手术干预的便利性仍然是一个讨论的主题:基于他们自己的研究结果,手术策略治疗局部晚期前列腺癌的支持者指出根治性前列腺切除术的有效性和相对安全性,反对者指出手术的高概率与手术、局部肿瘤复发、淋巴源性转移和远处转移的形成有关。评价腹腔镜根治性前列腺切除术联合盆腔扩大淋巴结切除术治疗前列腺癌T3a-3bN0M0的疗效。材料和方法。分析了32例46 ~ 71岁局部晚期前列腺癌患者手术治疗的围手术期、功能和肿瘤学结果。随访时间平均9-36个月(中位13个月)。平均手术总时间182.69±3.99 min,平均术中出血量253.06±9.80 ml。根据手术材料的组织学检查,在6.3%的患者中观察到高估疾病的临床分期。干预后,65.6%的男性保留了尿潴留功能,不需要纠正。所有患者术后6个月尿量、最大尿流率和平均尿流率均恢复正常,空后残留量有下降趋势。在整个随访期间,78.1%的患者没有生化复发的迹象。没有参与者因为死亡而退出研究。在过去的20年中,来自不同国家的作者团队在专业医学期刊上展示了至少80,000例局部晚期前列腺癌根治性手术治疗的即时和远程(随访期从3年到20年)结果,而排除在研究之外的标准是辅助治疗。作者的结论表明手术治疗局部晚期前列腺癌的有效性和相对安全性,以及扩大盆腔淋巴结切除术的重要性,这可以在必要时优化辅助治疗策略。我们自己的观察结果与文献数据完全可比较。目前,科学研究正以提高局部晚期前列腺癌手术治疗的效果为目标,特别是明确个体预后因素的作用,改进预测技术,选择合理的治疗措施方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes of radical prostatectomy in treatment of locally advanced prostate cancer: clinical observations
Background. Radical prostatectomy in treatment of locally advanced prostate cancer is currently recommended as one of the stages of multimodal therapy. Despite this, the expediency of surgical intervention remains a subject of discussion: based on the results of their own research, supporters of surgical tactics for treatment of locally advanced prostate cancer point to the effectiveness and relative safety of radical prostatectomy, opponents point to the high probability of a positive surgical edge associated with the operation, local tumor recurrence, lymphogenic metastasis, and formation of distant metastases.Aim. To evaluate the outcomes of laparoscopic radical prostatectomy performed in combination with expanded pelvic lymphadenectomy in treatment of prostate adenocarcinoma T3a–3bN0M0.Materials and methods. The perioperative, functional, and oncological results of surgical treatment of patients with locally advanced prostate cancer (n = 32) aged between 46 years to 71 years were analyzed. The follow-up period averaged 9–36 months (median 13 months).Results. Mean total duration of surgical intervention and mean volume of intraoperative blood loss were 182.69 ± 3.99 minutes and 253.06 ± 9.80 ml, respectively. Overestimation of the clinical stage of the disease, according to histological examination of the surgical material, was observed in 6.3 % of patients. After the intervention, the function of urinary retention was preserved and did not require correction in 65.6 % of men. In all patients 6 months after the operation, the urinary volume, maximum and mean urine flow rates were normalized, and there was a trend toward a decrease in the post-void residual volume. During the entire follow-up period, there were no signs of biochemical relapse in 78.1 % of patients. None of the participants dropped out of the study due to death.Conclusion. Over the last 20 years in specialized medical periodicals, author teams from various countries have shown the immediate and remote (follow-up period from 3 to 20 years) outcomes of radical surgical treatment of locally advanced prostate cancer in at least 80,000 patients in total, while the criterion for exclusion from research was adjuvant therapy. The authors’ conclusions indicate the effectiveness and relative safety of surgical treatment of locally advanced prostate cancer, as well as the importance of extended pelvic lymphadenectomy, which allows to optimize the tactics of adjuvant therapy if necessary. The results of our own observations are completely comparable with the literature data. Currently, scientific research is continuing with the aim of improving the outcomes of surgical treatment of locally advanced prostate cancer, in particular clarifying the role of individual prognostic factors, improving prediction techniques and choosing a rational scheme of treatment measures.
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