Murat UÇAR, Ali AKKOÇ, Taylan OKSAY, Tahsin ÇAPKIN, Sedat SOYUPEK, Alim KOŞAR

Laparoskopik Radikal Prostatektomi Deneyimlerimiz: Tek Merkez Sonuçları

Amaç: Kiliniğimizde laparoskopik radikal prostatektomi operasyonu yapılan hastaların özellikleri ile onkolojik ve fonksiyonel sonuçlarının değerlendirilmesi.Hastalar ve Yöntem: Kliniğimizde 2008-2011 yılları arasında baştan sona laparoskopik olarak yapılan 23 radikal prostatektomi vakası retrospektif olarak tarandı. Hastaların preoperatif özellikleri, perioperatif ve postoperatif komplikasyonları ve bunların tedavileri, biyokimyasal nüks oranları incelendi.Bulgular: Hastaların operasyon sonrası prostatektomi patolojileri 19 hastada Gleason skoru 3+3 (%82,6), 3 hastada 3+4 (%13), 1 hastada 4+3 (%4,3) olarak geldi. Cerrahi sınır 5 (%21,7) hastada pozitif (+) olarak tespit edildi. TNM 2009 evrelemesine göre 4 (%17,3) hastanın patolojisi T2a, 13 (%56,5) hastanın T2c, 5 (%21,7) hastanın T3a, 1 (%4,3) hastanın T3b olarak geldi. İki (%8,6) hastada postoperatif anastomoz kaçağı meydana gelmiş, 1 (%4,3) hastada ise vezikorektal fistül meydana gelmiştir. On beş (%65,2) hastada postoperatif dönemde erektil disfonksiyon (ED) gelişmiştir. Beş (%21,7) hasta anastomoz darlığı nedeniyle tekrar opere edilmiştir. Postoperatif 1. yılda 3 (%13) hastada biyokimyasal nüks saptanmıştır (prostat spesifik antijen (PSA) değeri >0,2 ng/ml). Sonuç: Onkolojik ve fonksiyonel sonuçlar açısından bakıldığında açık retropubik radikal prostatektomi (RRP) ve laparoskopik radikal prostatektomi (LRP) sonuçları benzerdir. Ancak LRP’de öğrenme eğrisi uzun olduğu için operasyon süresi ilk serilerde RRP’den daha uzundur. Öğrenme eğrisi tamamlandıktan sonra LRP postoperatif ağrı, kan transfüzyonu ihtiyacı, hastanede kalış süresi açısından RRP’ye göre daha avantajlı bir cerrahi tekniktir.

Anahtar Kelimeler:

Prostat Kanseri, Laparoskopi, Radikal Prostatektomi

Our Laparoscopic Radical Prostatectomy Experiences: Single Center Results

Aim: The aim of the study is to evaluate the characteristics and oncological and functional outcomes of patients operated with laparoscopic radical prostatectomy surgery at Our ClinicPatients and Method: 23 radical prostatectomy cases performed entirely laparoscopically at Our Clinic between 2008 and 2011 were reviewed retrospectively. Preoperative characteristics, perioperative and postoperative complications of the patients their treatments, and biochemical recurrence rates were evaluated.Results: Postoperative prostatectomy pathologies of patients were 3 + 3 in 19 (82.6%) patients, 3 + 4 in 3 (13%) patients and 4 + 3 in 1 (4.3%) patient. The surgical margin was positive in 5 (21.7%) patients. According to TNM 2009 staging, the pathology of 4 (17,3%) patients were T2a, 13 (56,5%) patients were T2c, 5 (21,7%) patients were T3a, and 1 (4,3%) patient was T3b. Postoperative anastomosis leakage occurred in 2 (8.6%) patients and vesicorectal fistula occurred in 1 (4.3%) patient. In 15 (65.2%) patients erectile dysfunction (ED) developed postoperatively. 5 (21.7%) patients were re-operated due to anastomotic stricture. Biochemical recurrence was detected in 3 (13%) patients after postoperative 1 year (prostate specific antigen (PSA) value > 0.2ng/ml). Conclusion: The results of open retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP) are similar in terms of oncologic and functional outcomes. However, because of the learning curve in LRP is long, in the first series operation period is longer than RRP. After completing the learning curve, LRP is a more advantageous surgical technique than RRP in terms of postoperative pain, needing for blood transfusion, and duration of hospital stay.

Keywords:

Prostate Cancer, Laparoscopy, Radical Prostatectomy,

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