Abstract：Objective： To evaluate the clinical efficacy and perioperative complications of radical prostatectomy in patients with oligometastatic prostate cancer. Method： The clinical data of 28 oligometastatic prostate cancer patients （the oligometastatic group）and 95 localized prostate cancer patients (the localized group) performed with laparoscopic radical prostatectomy were evaluated. The preoperative and postoperative PSA levels, complications incidence and hospital stays were analyzed between two groups. Result： Laparoscopic radical prostatectomy was performed successfully in both groups, there was no serious complications occurred during the operation. The incidence of minor complication and major complication was 21.4% vs. 0.0% in the oligometastatic group, and was 22.1% vs. 3.2% in the localized group respectively. Differences between two groups were no statistical significance (P > 0.05), the PSA level decreased significantly in both groups after one years of the operation. Conclusion： Oligometastatic prostate cancer is no longer a contraindication to laparoscopic radical prostatectomy. Most patients could get the opportunity to undergo a radical prostatectomy after neoadjuvant hormonal therapy, there was no significant increase in perioperative complications compared with localized prostate cancer. It suggests that multidisciplinary therapy based on radical prostatectomy can delay the cancer progression and exetend the survival time.
[1] SIEGEL RL, MILLER KD, JEMAL A.Cancer statistics,2019. CA Cancer J Clin, 2019,69(1):7-34. [2] ZHU Y, WANG HK, QU YY, et al.Prostate cancer in East Asia: evolving trend over the last decade. Asian J Androl, 2015,17(1):48-57. [3] 叶定伟,朱耀.中国前列腺癌的流行病学概述和启示.中华外科杂志,2015,53(4):249-252. [4] HELLMAN S, WEICHSELBAUM RR.Oligometastases. J Clin Oncol, 1995,13(1):8-10. [5] TOSOIAN JJ, GORIN MA, ROSS AE, et al.Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations. Nat Rev Urol, 2017,14(1):15-25. [6] HEIDENREICH A, BASTIAN PJ, BELLMUNT JA, et al.EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative Intent-Update 2013. Eur Urol, 2014,65(1):124-137. [7] SWEENEY CJ, CHEN YH, CARDUCCI M, et al.Chemohormonal therapy in metastatic Hormone-Sensitive prostate cancer. N Engl J Med, 2015,373(8):737-746. [8] SATKUNASIVAM R, KIM AE, DESAI M, et al.Radical Prostatectomy or External Beam Radiation Therapy vs No Local Therapy for Survival Benefit in Metastatic Prostate Cancer: A SEER-Medicare Analysis. J Urol, 2015,194(2):378-385. [9] GRATZKE C, ENGEL J, STIEF CG.Role of radical prostatectomy in metastatic prostate cancer: data from the Munich Cancer Registry. Eur Urol, 2014,66(3):602-603. [10] SHAO YH, KIM S, MOORE DF, et al.Cancer-specific survival after metastasis following primary radical prostatectomy compared with radiation therapy in prostate cancer patients: results of a population-based, propensity score-matched analysis. Eur Urol, 2014,65(4):693-700. [11] KIM DK, PARIHAR JS, KWON YS, et al.Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study. Asian J Androl, 2018,20(1):9-14. [12] GANDAGLIA G, FOSSATI N, STABILE A, et al.Radical prostatectomy in men with oligometastatic prostate cancer: results of a single-institution series with long-term follow-up. Eur Urol, 2017,72(2):289-292. [13] SHI T, GAO X, WANG HF, et al.Positive surgical margins in robot-assisted or open radical prostatectomy:A comparative study. Chin Med J (Engl), 2017,38(9):1134-1138. [14] 高强,张保,史玉强,等.新辅助内分泌治疗后行腹腔镜下前列腺癌根治术治疗局部晚期前列腺癌的临床分析.现代泌尿生殖肿瘤杂志,2018,10(3):145-148. [15] 潘家骅,迟辰斐,董柏君,等.多西他赛联合全雄阻断新辅助疗法治疗高危局部进展性前列腺癌的安全性.上海交通大学学报(医学版),2017,37(6):797-802. [16] MOHLER JL, ANTONARAKIS ES, ARMSTRONG AJ, et al.Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019,17(5):479-505. [17] TEWARI A, SOORIAKUMARAN P, BLOCH DA, et al.Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and Meta-Analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol, 2012,62(1):1-15. [18] 谢栋栋,王毅,陈磊,等.腹腔镜扩大盆腔淋巴结清扫在高危前列腺癌治疗中的应用.安徽医科大学学报,2015,50(12):1816-1818. [19] FOSSATI N, WILLEMSE PM, VAN DEN BROECK T, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol, 2017,72(1):84-109. [20] 李高翔,戴波,叶定伟,等.寡转移性前列腺癌根治术的临床初步疗效观察及围手术期并发症分析.中国癌症杂志,2017,27(1):20-25. [21] WILLIAMS SB, DAVIS JW, WANG X, et al.Neoadjuvant systemic therapy before radical prostatectomy in High-Risk prostate cancer does not increase surgical morbidity:contemporary results using the clavien system. Clin Genitourin Cancer, 2016,14(2):130-138.
