Curative effects of Retzius sparing robotic assisted laparoscopic radical prostatectomy through anterior path / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the curative effects of Retzius sparing robotic assisted laparoscopic radical prostatectomy(RARP) through anterior path.Methods From July 2015 to July 2017,75 patients undergoing Retzius sparing RARP(Rs-RARP group) and 75 patients undergoing conventional anterior approach RARP(CA-RARP group) were retrospectively reviewed.Preoperative data of patients was collected as follows:age of (68.6 ± 5.3) years,median prostate volume of 38.9 (20.6-60.1) m1,tPSA of (15.7 ± 3.3) ng/ml,BMI of (25.2 ± 3.6) kg/m2,biopsy Gleason score of 3 + 3 in 24 cases,3 + 4 in 28 cases,4 + 3 in 23 cases,cTMN T1c in 11 cases,T2a-T2b in 59 cases,T2c in 5 cases,in Rs-RARP group;age of (69.6 ± 5.6) years,median prostate volume of 38.3 (18.4-59.8)ml,tPSA of (17.6 ± 4.4) ng/ml,BMI of (27.5 ± 2.7) kg/m2,biopsy Gleason score of 3 + 3 in 29 cases,3 + 4 in 26 cases,4 + 3 in 20 cases,cTMN T1c in 17 cases,T2a-T2b in 51 cases,T2c in 7 cases,in CA-RARP group.The clinical data of the two groups,including operation time (OT),intraoperative blood loss,perioperative blood transfusion rate,24h/1m/3m/6m/12m continence situation and erectile function recovery,and postoperative oncological results were analyzed statistically.Results All cases were successfully performed robotically without conversion or major intraoperative or postoperative complications.For operative time,Rs-RARP group was (125.3 ± 15.6) mins and CA-RARP group was (108.4 ± 21.7) mins,and the difference was not statistically significant (P ＞ 0.05).For estimated blood loss (EBL),Rs-RARP group was (106.1 ± 10.3) ml,with perioperative blood transfusion in 2 cases (2.67％),and CA-RARP group was (82.2 ± 18.4)ml,with perioperative blood transfusion in 1 cases(1.33％).The Rs-RARP group had more EBL than the CA-RARP group(P ＜0.05).No difference was found in perioperative blood transfusion rate(P ＞ 0.05).The postoperative oral intake time was (1.5 ± 0.6) d,postoperative hospital stay was (8.0 ± 1.2) d,total hospitalization expense was (58.4 ± 13.2) thousand Yuan,and there were 5 cases (6.67％) with postoperative complications in Rs-RARP group,and was (2.0 ±0.6) d,(9.0 ± 1.8) d,(60.2 ± 16.4)thousand Yuan and 3 cases (4.00％) in corresponding items in CA-RARP group.No significant difference was found in the above mentioned parameters (all P ＞ 0.05).Postoperative pathology confirmed pT1c of 18 cases,T2a-T2b of 52 cases,and pT2c of 5 cases in Rs-RARP group and pT1c of 12 cases,T2a-T2b of 56 cases,pT2c of 7 cases in CA-RARP group (P ＞ 0.05).There was no significant difference between RsRARP and CA-RARP groups in the surgical positive margin (5 cases vs.4 cases,P ＞ 0.05).No tumor recurrence appeared for all cases (tPSA ＜0.2 ng/ml) during 12 months follow-up.The continence rate for Rs-RARP group and CA-RARP group were 84.0％ (63/75) vs.28.0％ (21/75) (24h postoperatively),90.7％ (68/75) vs.46.7％ (35/75) (1 month postoperatively),93.3 ％ (70/75) vs.57.3％ (43/75)(3 months postoperatively),96.0％ (72/75) vs.89.3％ (67/75) (6 months postoperatively) and 100％ (75/75) vs.96.3％ (72/75) (1 year postoperatively).Rs-RARP group showed superiority in continence recovery at 24 h and 1,3 months postoperatively (all P ＜ 0.05),but no statistical differences at 6,12 months postoperatively(all P ＞ 0.05).On erectile function,Rs-RARP group was significantly better than the conventional group at 1,3,6,12 months postoperatively in ≤75-year-old patients(all P ＜ 0.05).But in ＞ 75-year-old patients,two groups had no difference during the follow-up (all P ＞ 0.05).Conclusions Retzius sparing RARP through anterior path can treat early and intermediate stage prostate cancer effectively,and continence and erectile function recovered shortly.