Abstract：Objective: To discuss the operative difficulties and skills in robot-assisted laparoscopic radical prostatectomy (RALP) in the management of complicated prostate cancer so as to improve the operation technique. Methods: The clinical data of 126 cases of complicated prostate cancer receiving RALP from January 2013 to February 2017 in our department were collected and retrospectively analyzed, in which 48 cases received endocrine therapy (38.1%), there were 33 cases after TURP or open prostatectomy (26.2%), 29 cases of large volume prostate cancer (the volume of prostate ≥100 mL) (23.0%), 16 cases (12.7%) of middle lobe of prostate protruding into bladder. Pelvic lymphadenectomy was performed at the same time for high-risk prostate cancer. Results: All the 126 cases were operated successfully and there was no open conversion, no rectal injury and no blood transfusion. The average blood loss was 95 mL (range, 45-330 mL). Average operative time was 136 min (86-191 min), and the average postoperative hospital stay was 7.8 d (5-12 d). The pathological margin was positive in 15 cases (11.9%), and lymph nodes were positive in 7 cases (5.6%). The urine leak occurred in 3 cases, and lymphatic leak in 5 cases, which were cured 1-3 weeks after operation. Anastomotic stricture occurred in one case. After urethral dilatation, the urine was unobstructed. The patients were followed up for 26 (3-46) months after RALP. The continence rate was 86.5% within 1 year. Biochemical recurrence rate was 7.1%. Conclusions: RALP is a safe and efficacious surgical modality in the management of complicated prostate cancer. Through reasonable technical optimization, the operation difficulty can be obviously reduced.
[1] Chen W, Zheng R, Zhang S, et al. Cancer incidence and mortality in China, 2013. Cancer Lett, 2017,401(10):63-71. [2] Chen R, Sjoberg DD, Huang Y, et al. Prostate specific antigen and prostate cancer in Chinese men undergoing initial prostate biopsies compared with western cohorts. J Urol, 2017,197(1):90-96. [3] Chia SJ, Heng CT, Chan SP, et al. Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int, 2003,91(4):371-374. [4] Heidenreich A, Pfister D, Porres D. Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases: results of a feasibility and case-control study. J Urol, 2015,193(3):832-838. [5] 王海峰,杨波,高旭,等.机器人前列腺癌根治术治疗大体积前列腺癌的难点与技巧分析.临床泌尿外科杂志,2014,29(4):281-286. [6] El-Hakim A, Leung RA, Richstone L, et al. Athermal robotic technique of prostatectomy in patients with large prostate glands (>75 g): technique and initial results. BJU Int, 2006,98(1):47-49. [7] Singh A, Fagin R, Shah G, et al. Impact of prostate size and body mass index on perioperative morbidity after laparoscopic radical prostatectomy. J Urol, 2005,173(2):552-554. [8] 刘茁,孟一森,张骞,等.经尿道前列腺电切术后的三孔法腹腔镜下根治性前列腺切除术临床分析.中华泌尿外科杂志,2016,37(8):628-629. [9] Menard J, De La Taille A, Hoznek A, et al. Laparoscopic radical prostatectomy after transurethral resection of the prostate: surgical and functional outcomes. Urology, 2008,72(3):593-597. [10] Porpiglia F, Bertolo R, Manfredi M, et al. Total anatomical Reconstruction during robot-assisted radical prostatectomy: implications on early recovery of urinary continence. Eur Urol, 2016,69(3):485-495. [11] Galfano A, Ascione A, Grimaldi S, et al. A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol, 2010,58(3):457-461. [12] Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol, 2000,163(6):1643-1649. [13] Walz J, Epstein JI, Ganzer R, et al. 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(2):301-311. [14] 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(3):431-452. [15] Kang SG, Schatloff O, Haidar AM, et al. Overall rate, location, and predictive factors for positive surgical margins after robot-assisted laparoscopic radical prostatectomy for high-risk prostate cancer. Asian J Androl, 2015,18(1):123-128. [16] Lee D, Choi SK, Park J, et al. Comparative analysis of oncologic outcomes for open vs. robot-assisted radical prostatectomy in high-risk prostate cancer. Korean J Urol, 2015,56(8):572-579. [17] Punnen S, Meng MV, Cooperberg MR, et al. How does robot-assisted radical prostatectomy (RARP) compare with open surgery in men with high-risk prostate cancer? BJU Int, 2013,112(4):E314-E320. [18] Harty NJ, Kozinn SI, Canes D, et al. Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy. Int Braz J Urol, 2013,39(5):639-646; discussion 647-648. [19] Ficarra V, Cavalleri S, Novara G, et al. Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol, 2007,51(1):45-55; discussion 56. [20] 艾青,李宏召,马鑫,等.机器人辅助腹腔镜前列腺根治性切除术中尿控和性功能保留的关键手术技巧.微创泌尿外科杂志,2017,6(1):59-61. [21] Patel VR, Palmer KJ, Coughlin G, et al. Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol, 2008,22(10):2299-2305.
