机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术治疗局部进展期前列腺癌的回顾性临床分析

目的:评估机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术治疗局部进展期前列腺癌的安全性及其疗效.方法:回顾性分析2015年12月-2019年12月我院收治的112例局部进展期前列腺癌患者的临床资料,放射性核素骨扫描排除骨转移后,行机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术,统计患者手术时间、术中出血...     

机器人辅助腹腔镜前列腺癌根治术联合新辅助内分泌治疗高危前列腺癌的临床研究

目的:探讨术前机器人辅助腹腔镜前列腺癌根治术(Robot-assisted laparoscopic radical prostatectomy,RALP)联合新辅助内分泌治疗(Neoadjuvant hormone therapy,NHT)治疗高危前列腺癌患者的临床疗效。方法:回顾性分析甘肃省人民医院泌尿外科自2018年6月-2020年12月前通过PSA、穿刺活检及MRI确诊的35例高危前列腺癌患者临床资料,其中术前行RALP+NHT治疗组25例,年龄为56~81(70.28±7.07)岁;RALP治疗组10例,年龄为49~86(69.20±8.77)岁。比较两组患者的手术时间、术中出血量、术后住院时间、术后切缘阳性率及术中和术后并发症等情况。结果:所有患者手术均获成功,无中转开放及二次手术。与RALP治疗组相比,RALP+NHT治疗组在手术时间[237.88±68.99d Vs (277±76.69)d,P=0.541]、术中出血量[(149.60±149.84)ml Vs (225±268.56)ml,P=0.266]、术后住院时间[(11±4.31) d Vs(11.7±4.86) d,P=0.402]、术后留置尿管时间[(28±6.81) d Vs (28±6.81) d,P=0.464]和术前PSA值[(49.97±32.22)ng/ml Vs (47.41±23.14)ng/ml,P=0.089]等方面差异均无统计学意义;RALP+NHT治疗组在总住院时间[(18.08±4.44)d Vs (25.5±10.82)d,P<0.005]和术后留置引流管时间[(10.12±3.36)d Vs(11.10±5.17)d,P=0.014]明显低于RALP组,差异具有统计学意义;RALP+NHT治疗组在Gleason评分(24%Vs10%)、肿瘤切缘阳性(12%Vs 20%)及并发症(4%Vs 10%)等方面下降明显。结论:术前RALP联合NHT可降低高危前列腺癌切缘阳性、改善病理分级,使高危患者受益。     

机器人辅助腹腔镜前列腺癌根治术

前列腺癌好发于中老年男性,是目前最常见的泌尿系统恶性肿瘤之一.在美国,前列腺癌是发病率仅次于皮肤癌的男性恶性肿瘤,在肿瘤相关死亡原因中排在第二位.随着社会的人口老龄化、生活习惯的改变、前列腺癌检出率的提高,我国前列腺癌的发病率正逐年上升.关于前列腺癌的手术治疗近年有较多进展,其中手术机器人的出现使前列腺癌的微创外科治疗进入了新的时代,现简单阐述如下.     

机器人辅助腹腔镜前列腺癌根治术治疗高危局部进展期前列腺癌临床疗效分析

目的:探究机器人辅助腹腔镜前列腺癌根治术治疗高危局部进展期前列腺癌的疗效,为临床提供理论参考.方法:选取华中科技大学同济医学院附属协和医院泌尿外科2016年1月-2020年10月收治的237例高危局部进展期前列腺癌患者作为研究对象,分为观察组129例和对照组108例.对照组采用常规腹腔镜根治术治疗,观察组经机器人辅助行...     

前列腺癌根治术综合新辅助治疗及辅助治疗对局部控制及生存率的影响

目的评估前列腺癌根治术（RP）综合新辅助（NHT）及辅助治疗（AT）对局部控制及生存率的疗效。方法 38例前列腺癌（Pca）患者,在RP前均行NHT,其中18例行辅助内分泌治疗及放疗,20例为对照组,两组临床病理特征及预后进行比较。结果 NHT后,PSA水平均明显下降（P=0.000）,20（53%）例病理分期下降。AT组有较高的NHT前PSA、分期、Gleason评分、精囊侵犯及切缘阳性率（P〈0.05）,随访7.6年,预后仍可与照组相比拟。5年及10年无生化复发率,AT组为75.9%,62.6%,对照组为78.8%,72.2%（P=0.635）;无局部复发率,AT组均为88.5%,对照组均为94.4%（P=0.53）;疾病特异生存率,AT组为93%,81.7%,对照组均为100%（P=0.114）;整体生存率,AT组为87.5%,76.6%,对照组均为94.4%（P=0.234）。结论 RP综合NHT及AT对局部控制及生存率可能得到明显的益处。     

新辅助内分泌治疗联合腹腔镜前列腺癌根治术治疗高危及局部晚期前列腺癌的临床研究

目的:探讨新辅助内分泌治疗联合腹腔镜前列腺癌根治术治疗高危及局部晚期前列腺癌的可行性及临床效果。方法:回顾性分析2015年1月～2017年1月临沂市中心医院确诊的36例高危及局部晚期前列腺癌患者临床资料,先行3个月辅助内分泌治疗,再行腹腔镜前列腺癌根治术,术后即刻给予辅助内分泌治疗。结果:手术均获得成功,无中转开放手术。平均手术时间为(201±21) min,平均出血量为(240±122) ml,平均住院时间为(20.6±2.3) d,平均术后留置尿管和引流管时间分别为(14.8±3.8) d和(5.6±2.8) d,切缘阳性5例(13.9%),淋巴结阳性11例(30.6%),术后尿失禁2例,尿瘘1例,勃起功能障碍22例。术后随访12～36个月,平均24个月,术后1年尿控满意率为91.6%(33/36),术后1、2年生化复发率分别为25.0%(9/36)和38.9%(14/36)。结论:新辅助内分泌治疗联合腹腔镜下前列腺癌根治术治疗高危及局部晚期前列腺癌安全、可行,但有较高的淋巴结阳性率和生化复发率,术后需要进一步治疗及随访观察。     

保留神经的机器人辅助腹腔镜前列腺癌根治术研究进展

da Vinci机器人外科系统自问世以来,正越来越多地被运用在前列腺癌手术中。相较于其他术式,机器人辅助腹腔镜前列腺癌根治术具有三维腔镜视野、操作稳定灵活、学习曲线较短等优势,被认为是最有前景的手术方法,但其仍有一定的手术切缘阳性、术后勃起障碍和尿失禁等并发症发生率。作者将就机器人辅助腹腔镜前列腺癌根治术的手术效果、术后并发症及其解剖学基础作一综述。     

局部进展期直肠癌新辅助治疗研究进展

目的 分析各新辅助治疗策略的优劣,为临床诊疗提供参考,并为进一步研究探索提供方向。方法 检索并查阅近年来国内外医学数据库（PubMed、EMBASE、Cochrane Library、维普数据库、中国知网、万方数据库等）,对局部进展期直肠癌新辅助治疗的相关文献进行综述。结果 新辅助治疗可以降低肿瘤分期、提高保肛率、降低局部复发率,但并未显著降低远处转移率和侧方淋巴结转移率,也未改善长期生存。越来越多的优化新辅助方案应运而生。分子靶向药物和免疫治疗正被尝试应用于临床,结合新兴生物学标志物的研究,以提高局部进展期直肠癌患者的疗效,并减少治疗相关副作用,改善患者的生存获益。结论 新辅助治疗是局部进展期直肠癌标准治疗策略,对新辅助治疗模式的探索有望进一步提高治疗效果、减轻毒副反应,并改善生存预后。通过结合肿瘤分子生物学指标识别和筛选获益人群,有望成为未来研究的重要方向。     

机器人辅助腹腔镜下前列腺癌根治术的研究现状

在过去的10年中,随着机器人手术系统的不断改进及应用的拓宽,机器人辅助腹腔镜下前列腺癌根治术（robot—assisted laparoscopic prostatectomy,RALP）的报道迅速增多,仅2009年全球超过了60,000例,占前列腺癌根治术的70%,在前列腺高发的美国及欧洲大部分等国家,RALP几乎取代了单纯腹腔镜下前列腺癌根治术（laparoscopic radical prostateetomy,LRP）和传统开放耻骨后前列腺癌根治术（radical retropubic prostatect—omy,RRP）,有着广泛的应用前景。     

Prognostic factors for and outcome of locally advanced prostate cancer after radical prostatectomy

Study Type – Therapy (case series)
Level of Evidence 2b

OBJECTIVE

To present the outcomes of cT3N0M0 prostate cancer after radical prostatectomy (RP) and determine the prognostic factors in biochemical progression‐free survival (BPFS), clinical progression‐free survival (CPFS), cancer‐specific survival (CSS) and overall survival (OS) after long‐term follow‐up of 10 years.

PATIENTS AND METHODS

In all, 164 patients who were assessed as clinical T3 prostate cancer by digital rectal examination (DRE), underwent RP and bilateral pelvic lymphadenectomy at Erasmus MC between 1977 and 2004 without neoadjuvant treatment. Preoperative staging computed tomography showed no signs of metastasis. Kaplan–Meier curves were constructed to show BPFS, CPFS, CSS and OS. Cox proportional hazard analysis was used to determine prognostic indicators of disease progression.

RESULTS

The mean (range) follow‐up was 100 (1–291) months. At 5, 10 and 15 years, BPFS was 50.4%, 43.0% and 38.3%, respectively, CPFS was 79.7%, 68.7% and 63.5%, CSS was 93.4%, 80.3% and 66.3%, and OS was 87.1%, 67.2% and 37.4%. Multivariate Cox proportional hazard analysis showed that surgical tumour grade, margin and node status were significant factors in CPFS and CSS. Surgical tumour grade, node status and preoperative PSA level were significant factors in BPFS

CONCLUSION

RP for clinically locally advanced prostate cancer may produce acceptable long‐term BPFS, which is comparable with published results of radiotherapy with adjuvant endocrine therapy. Pathological tumour grade and node status were significant predicting factors in BPFS and CPFS, as well as tumour‐specific survival after 100 months follow‐up.     

新辅助内分泌治疗结合机器人辅助根治性前列腺切除术治疗高危前列腺癌的优势

目的：探讨高危前列腺癌患者行新辅助内分泌治疗（neoadjuvant hormonal therapy, NHT）后,行机器人辅助腹腔镜根治性前列腺切除术（robot-assisted laparoscopic radical prostatectomy, RALRP）较腹腔镜根治性前列腺切除术（laparoscopic radical prostatectomy, LRP） 和耻骨后根治性前列腺切除术 （ retropubic radical prostatectomy, RRP）的优势。方法：回顾性分析我院自2010年3月-2012年1月以新辅助内分泌治疗结合根治性前列腺切除术治疗的16例高危前列腺癌的临床资料。术前采取3-6个月的LHRH-a＋抗雄药物的最大程度雄激素阻断方法（maximal androgen blockage,MAB）作为NHT方案,NHT后PSA均降至0．2μg／L以下。之后,其中5例接受RALRP,5例接受LRP,6例接受RRP。三组患者治疗前基线情况（年龄、PSA水平、Gleason评分）差异无统计学意义（P〉0．05）。结果：手术均获成功。中位手术时间（operating time,OT）、失血量（esti-mated blood loss,EBL）、住院天数（hospital stay,HS）在RALRP组为225min（包括机器人到位15min）、600mI、7d,在LRP组为280min、900mi、7d,在RRP组为150min、675ml、14．5d。三组患者术后均无尿漏,术后3天拔除双侧引流管。术后病理均无切缘阳性。三组各有1例患者在术后3个月时因PSA复燃而接受辅助性内分泌治疗（P=1．00）。术后3个月时,除2例RRP组患者尚存压力性尿失禁,其余患者均恢复尿控（P=0．29）。结论：对于接受NHT的高危前列腺癌患者而言,相对于开放手术和腹腔镜根治性前列腺切除术,机器人辅助腹腔镜根治性前列腺切除术仍然是这些患者的更佳选择。     

即刻辅助内分泌治疗在高危局限期或局部晚期前列腺癌根治性手术后的应用价值

目的:以术后2年PSA复发率评价高危局限期或局部晚期前列腺癌根治性手术后即刻辅助内分泌治疗(AHT)的疗效。方法:回顾性总结在2010年9月至2012年3月在我院泌尿外科确诊为高危局限期或者局部晚期的62例前列腺癌患者。所有患者在术前(腹腔镜或耻骨后前列腺癌根治术)均行MRI、ECT(全身骨显像检查),均未发现有区域盆腔淋巴结及骨转移。其中32例患者(A组)在手术后2周至1个月内给予辅助内分泌治疗(AHT),包括口服及注射药物;30例患者(B组)术后未采取任何处理措施。所有患者在术后每3个月复查1次PSA,每6个月行1次ECT检查,每3个月随访1次(包括患者的药物不良反应、用药持续时间及剂量、生存质量),共计2年。结果:A组中有7例患者生化复发,其2年的总体无生化复发率为78.13%。B组中有14例生化复发,其2年的总体无生化复发率为53.33%(P0.05)。结论:高危局限期或局部晚期前列腺癌根治性手术后即刻AHT可以提高患者无生化复发生存率,对控制该疾病的进一步发展甚至术后的转移有重要意义。     

A prospective and randomized study of primary hormonal therapy for patients with localized or locally advanced prostate cancer unsuitable for radical prostatectomy: results of the 5-year follow-up

OBJECTIVE: To evaluate the effect of primary hormonal therapy for patients with localized and locally advanced prostate cancer. PATIENTS AND METHODS: Patients with stage T1b-T3 prostate cancer who were not scheduled for radical prostatectomy were allocated into two groups: group 1 (73 men) received luteinizing hormone-releasing hormone (LHRH) agonist monotherapy and group 2 (78 men) received LHRH agonist and chlormadinone acetate. Patients were followed using serum prostate specific antigen levels, prostate size and the detection of distant metastasis for 5 years. RESULTS: The median (range) follow-up was 78 (63-87) months. The 5-year progression-free survival rate was significantly higher in group 2 (68%) than in group 1 (47%). However, the overall and cause-specific survival rate at 5 years were similar in both groups, at 72% and 93% in group 1, and 64% and 89% in group 2, respectively. CONCLUSION: The overall survival rates of the both groups were no different from that of the normal Japanese population of the same age group. Although this study did not include an untreated group, i.e. watchful waiting, these results might indicate the usefulness of primary hormonal therapy in controlling localized and locally advanced prostate cancer. The 5-year observation period is still short and the study is continuing to determine the 10-year survival.     

前列腺偶发癌的新辅助疗法加前列腺癌根治术治疗

目的探讨偶发性前列腺癌患者的最佳治疗方法。方法2001年1月～2005年1月,对18例前列腺增生症行TURP术后病理证实为前列腺癌的病人,先行新辅助治疗后,进而行前列腺痛根治术,满意效果。新辅助治疗方案包括(1)诺雷德 Flutamide(氟他胺):(2)诺雷德 Casodex(康士德),用药时间为3月,用药期间监测PSA。手术方法为标准的保留勃起神经的前列腺癌根治术。结果所有病人药物耐受性良好,手术和围手术期过程顺利。术后随访6月～3年4个月,平均12月,12例膀胱控尿正常,3个月时有轻度压力性尿失禁6例,6个月时有2例,无真性尿失禁发生。随访期间18例病人血清PSA均<0．01μg／L,未发现肿瘤局部复发以及远处转移征象。7例患者保持性功能正常。结论前列腺癌根治术是偶发性前列腺癌患者的有效疗法。术前应用新辅助治疗3月,可使TURP术造成的创面完全愈合,减少根治手术的难度,同时控制前列腺癌的发展。     

Perioperative complications of radical retropubic prostatectomy in patients with locally advanced prostate cancer: a comparison with clinically localized prostate cancer

Radical prostatectomy (RP) continues to be an effective surgical therapy for prostate carcinoma, particularly for organ-confined prostate cancer (PCa). Recently, RP has also been used in the treatment of locally advanced prostate cancer. However, little research has been performed to elucidate the perioperative complications associated with RP in patients with clinically localized or locally advanced PCa. We sought to analyse the incidence of complications in these two groups after radical retropubic prostatectomy (RRP). From June 2002 to July 2010, we reviewed 379 PCa patients who underwent RRP in our hospital. Among these cases, 196 had clinically localized PCa (T_1a–T_2c: group 1), and 183 had locally advanced PCa (≥T_3a: group 2). The overall complication incidence was 21.9%, which was lower than other studies have reported. Perioperative complications in patients with locally advanced PCa mirror those in patients with clinically localized PCa (26.2% vs. 17.8%, P=0.91). Our results showed that perioperative complications could not be regarded as a factor to consider in regarding RP in patients with cT₃ or greater.     

Impact of hormonal therapy prior to radical prostatectomy on the recovery of quality of life

BACKGROUND: We investigated the changes in health-related quality of life (HRQOL) in patients who underwent prostatectomy (RP) with or without neoadjuvant hormonal therapy (NHT). METHODS: A total of 72 patients undergoing direct RP (DRP group) and 26 patients receiving neoadjuvant hormonal therapy (NHT group) were enrolled in the present study. The baseline interview was conducted before RP (not initiation of therapy). Follow-up interviews were conducted in person at scheduled study visits of 3, 6, and 12 months after surgery. We measured general and disease specific HRQOL with the Medical Outcomes Study 36-Item Short Form and University of California, Los Angeles Prostate Cancer Index, respectively. RESULTS: At baseline, the NHT group scored statistically lower for not only sexual function (P < 0.001), but also the general HRQOL, such as role limitations due to physical problems (P = 0.007), social function (P = 0.045) and mental health (P = 0.034), than the DRP group. The NHT group reported lower scores in social function and mental health at 3 months (P = 0.040 and 0.006, respectively). Patients who received NHT for more than 3 months continued to show significantly lower scores for some HRQOL domains 12 months later. CONCLUSION: Neoadjuvant hormonal therapy may decrease not only sexual function, but also general HRQOL before surgery. The recovery of HRQOL appeared to be further prolonged in patients who received long-term NHT.     

Role of robot‐assisted radical prostatectomy in locally advanced prostate cancer

Locally advanced prostate cancer is regarded as a very high‐risk disease with a poor prognosis. Although there is no definitive consensus on the definition of locally advanced prostate cancer, radical prostatectomy for locally advanced prostate cancer as a primary treatment or part of a multimodal therapy has been reported. Robot‐assisted radical prostatectomy is currently carried out even in high‐risk prostate cancer because it provides optimal outcomes. However, limited studies have assessed the role of robot‐assisted radical prostatectomy in patients with locally advanced prostate cancer. Herein, we summarize and review the current knowledge in terms of the definition and surgical indications of locally advanced prostate cancer, and the surgical procedure and perisurgical/oncological outcomes of robot‐assisted radical prostatectomy and extended pelvic lymphadenectomy for locally advanced prostate cancer.     

Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer

Study Type – Therapy (retrospective cohort analysis) Level of Evidence 2b What's known on the subject? and What does the study add? Prostate cancer is generally considered to be high risk when the prostate‐specific antigen (PSA) concentration is >20 ng/mL, the Gleason score is ≥8 or the American Joint Commission on Cancer (AJCC) tumour (T) category is ≥2c. There is no consensus on the best treatment for men with prostate cancer that includes these high‐risk features. Options include external beam radiation therapy (EBRT) with androgen suppression therapy (AST), treatment with a combination of brachytherapy, EBRT and AST termed combined‐modality therapy (CMT) or radical prostatectomy (RP) followed by adjuvant RT in cases where there are unfavourable pathological features, e.g. positive surgical margin, extracapsular extension and seminal vesicle invasion. While outcomes for both approaches have been published independently these treatments have not been compared in the setting of a prospective RCT where confounding factors related to patient selection for RP or CMT would be minimised. These factors include age, known prostate cancer prognostic factors and comorbidity. RCTs that compare RP to radiation‐based regimens have been attempted but failed to accrue.

OBJECTIVE

• ? To assess the risk of prostate cancer‐specific mortality after therapy with radical prostatectomy (RP) or combined‐modality therapy (CMT) with brachytherapy, external beam radiation therapy (EBRT) and androgen‐suppression therapy (AST) in men with Gleason score 8–10 prostate cancer.

PATIENTS AND METHODS

• ? Men with localised high‐risk prostate cancer based on a Gleason score of 8–10 were selected for study from Duke University (285 men), treated between January 1988 and October 2008 with RP or from the Chicago Prostate Cancer Center or within the 21st Century Oncology establishment (372) treated between August 1991 and November 2005 with CMT.
• ? Fine and Gray multivariable regression was used to assess whether the risk of prostate cancer‐specific mortality differed after RP as compared with CMT adjusting for age, cardiac comorbidity and year of treatment, and known prostate cancer prognostic factors.

RESULTS

• ? As of January 2009, with a median (interquartile range) follow‐up of 4.62 (2.4–8.2) years, there were 21 prostate cancer‐specific deaths.
• ? Treatment with RP was not associated with an increased risk of prostate cancer‐specific mortality compared with CMT (adjusted hazard ratio [HR] 1.8, 95% confidence interval [CI] 0.6–5.6, P= 0.3).
• ? Factors associated with an increased risk of prostate cancer‐specific mortality were a PSA concentration of <4 ng/mL (adjusted HR 6.1, 95% CI 2.3–16, P < 0.001) as compared with ≥4 ng/mL, and clinical category T2b, c (adjusted HR 2.9; 95% CI 1.1–7.2; P= 0.03) as compared with T1c, 2a.

CONCLUSION

• ? Initial treatment with RP as compared with CMT was not associated with an increased risk of prostate cancer‐specific mortality in men with Gleason score 8–10 prostate cancer.