Furkan ŞENDOĞAN, Volkan TUĞCU, Turgay TURAN, Selçuk ŞAHİN, Özgür EFİLOĞLU, Asıf YILDIRIM

5422

Yüksek riskli prostat kanserli hastalarda açık retropubik ve robot yardımlı radikal prostatektominin onkolojik ve fonksiyonel sonuçları

Amaç: Çalışmamızda yüksek riskli prostat kanserine sahip hastalarda uygulanan açık ve robot yardımlı prostatektominin onkolojik ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Çalışmamızda deneyimli iki merkez tarafından 2014-2018 yılları arasında 118 açık radikal prostatektomi (ORP) ve 66 robot-yardımlı radikal prostatektomi (RARP) uygulanan yüksek risk prostat kanserine sahip hastaların dataları retrospektif olarak değerlendirilmiştir. D’Amico risk sınıflamasına göre prostat spesifik antijen (PSA)>20 ng/ml veya Gleason skor >7 (ISUP-grade 4/5) veya klinik evre ≥ T2c komponentlerinden herhangi birine sahip hastalar yüksek riskli prostat kanseri olarak kabul edilmiştir. Hastalara operasyon öncesi uzak metastazı dışlamak ve ekstrakapsüler yayılım riskini değerlendirmek amacıyla tüm abdomen manyetik rezonans görüntüleme (MRG) ve kemik sintigrafisi gerçekleştirilmiştir. Hastaların iki defa ardışık olarak değerlendirilen PSA değerinin ≥ 0.2 ng/mL olması biyokimyasal rekürrens olarak kabul edilmiştir. Üriner kontinans ped kullanım durumu ile erektil fonksiyon ise fosfodiesteraz tip-5 inhibitörü kullanımı ile veya kullanılmadan gerçekleştirilen vajinal penetrasyonun sözel sorgulanması ile tanımlanmıştır.Bulgular: Çalışmamızda preoperatif PSA değeri, prostat biyopsi Uluslararası Ürolojik Patoloji Topluluğu (ISUP) derecesi ve klinik evre ORP grubunda istatistiksel anlamlı düzeyde daha yüksek saptanmıştır. Her iki grup arasında pozitif cerrahi sınır, ekstrakapsüler yayılım, seminal vezikül invazyonu ve lenf nod invazyonu açısından anlamlı bir fark saptanmamıştır. Biyokimyasal rekürrens ORP grubunda daha yüksek saptanmış olup androjen deprivasyon tedavisi ve radyoterapi gibi adjuvan tedaviler açısından her iki grup arasında anlamlı bir fark saptanmamıştır. Her iki grupta hastaların birinci yıl değerlendirmelerinde üriner inkontinans ve erektil disfonksiyon açısında anlamlı bir fark bulunmamıştır. Ortalama takip süresi RARP ve ORP için sırasıyla 15,55 ve 46,45 aydır.Sonuç: Yüksek riskli prostat kanserinde uygulanan açık ve robot yardımlı prostatektomi onkolojik ve fonksiyonel olarak benzer sonuçlara sahiptir.
Anahtar Kelimeler:

Radikal prostatektomi, Robot-yardımlı radikal prostatektomi, Yüksek riskli prostat kanseri, Açık retropubik radikal prostatektomi

Oncologic and functional outcomes of open retropubic vs robot-assisted radical prostatectomy in patients with high risk prostate cancer

Objective: The aim of this study is to evaluate oncological and functional outcomes of open radical prostatectomy (ORP) and robot-assisted prostatectomy (RARP) in patients with high-risk prostate cancer.Material and Methods: In our study, patients with high-risk prostate cancer who underwent 118 ORP and 66 RARP between 2014-2018 have been evaluated retrospectively. Patients with prostate specific antigen (PSA)>20 ng/ml or Gleason score >7 or clinical stage ≥T2c according to D’Amico risk classifications are considered to high-risk prostate cancer. Preoperative abdominal magnetic resonance imaging (MRI) and bone scintigraphy were performed in each patient to assess the risk of extracapsular extension and exclude metastasis. The PSA value of 0.2 ng/mL in patients following two consecutive evaluations is accepted as biochemical recurrence. Urinary continence with pad use and erectile function were evaluated by verbal questioning of vaginal penetration performed with or without the use of phosphodiesterase type-5 inhibitors.Results: In our study; preoperative PSA values, prostate biopsy ISUP grade, and clinical stage were found significantly higher in the ORP group. There was no significant difference between the groups in terms of positive surgical margin, extracapsular extension, seminal vesicle, and lymph node invasion. Biochemical recurrence was higher in the ORP group but there was no significant difference between the groups in terms of adjuvant treatments such as radiotherapy and androgen deprivation therapy. And there was no significant difference in urinary incontinence and erectile dysfunction in the first-year assessments of patients. Median follow-up was 15.55 and 46.45 months for RARP and ORP, respectively. Conclusion: ORP and RARP have similar oncological and functional outcomes in high-risk prostate cancer. 
Keywords:

Robot-assisted radical prostatectomy, high risk prostate cancer, open retropubic radical prostatectomy,

PDF

___

  • Referans1. Siegel, R.L., et al., Cancer Statistics, 2021. 2021. 71(1): p. 7-33
  • Referans2. Cooperberg MR, Cowan J, Broering JM, Carroll PR. High-risk prostate cancer in the United States, 1990-2007. World J Urol. 2008 Jun;26(3):211-8. doi: 10.1007/s00345-008-0250-7. Epub 2008 Mar 28. PMID: 18369637; PMCID: PMC2948572.
  • Referans3. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. 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 Jul;62(1):1-15. doi: 10.1016/j.eururo.2012.02.029. Epub 2012 Feb 24. PMID: 22405509.(*)
  • Referans4. Surcel CI, Sooriakumaran P, Briganti A, De Visschere PJ, Fütterer JJ, Ghadjar P, et al. Members of Prostate Cancer Working Group of Young Academic Urologists Working Party; Members of Young Urologists Office of European Association of Urology. Preferences in the management of high-risk prostate cancer among urologists in Europe: results of a web-based survey. BJU Int. 2015 Apr;115(4):571-9. doi: 10.1111/bju.12796. Epub 2014 Aug 11. PMID: 24802335.
  • Referans5. Dell'Oglio P, Karnes RJ, Joniau S, Spahn M, Gontero P, Tosco L, et al.; European Multicenter Prostate Cancer Clinical and Translational Research Group (EMPaCT). Very long-term survival patterns of young patients treated with radical prostatectomy for high-risk prostate cancer. Urol Oncol. 2016 May;34(5):234.e13-9. doi: 10.1016/j.urolonc.2015.11.018. Epub 2015 Dec 17. PMID: 26706120.(*)
  • Referans6. Mitchell CR, Boorjian SA, Umbreit EC, Rangel LJ, Carlson RE, Karnes RJ. 20-Year survival after radical prostatectomy as initial treatment for cT3 prostate cancer. BJU Int. 2012 Dec;110(11):1709-13. doi: 10.1111/j.1464-410X.2012.11372.x. Epub 2012 Aug 30. PMID: 22934913.(*)
  • Referans7. N Mottet , P Cornford , R.C.N. van den Bergh, E Briers , M De Santis, S Fanti, et al. European Association, U., European Association of Urology Guidelines. 2020 Edition. Vol. presented at the EAU Annual Congress Amsterdam 2020. 2020, Arnhem, The Netherlands: European Association of Urology Guidelines Office.
  • Referans8. Lowrance WT, Eastham JA, Savage C, Maschino AC, Laudone VP, Dechet CB, et al. Contemporary open and robotic radical prostatectomy practice patterns among urologists in the United States. J Urol. 2012 Jun;187(6):2087-92. doi: 10.1016/j.juro.2012.01.061. Epub 2012 Apr 11. PMID: 22498227; PMCID: PMC3407038.
  • Referans9. Busch J, Magheli A, Leva N, Hinz S, Ferrari M, Friedersdorff F, et al. Matched comparison of outcomes following open and minimally invasive radical prostatectomy for high-risk patients. World J Urol. 2014 Dec;32(6):1411-6. doi: 10.1007/s00345-014-1270-0. Epub 2014 Mar 9. PMID: 24609219.(*)
  • Referans10. Punnen S, Meng MV, Cooperberg MR, Greene KL, Cowan JE, Carroll PR. How does robot-assisted radical prostatectomy (RARP) compare with open surgery in men with high-risk prostate cancer? BJU Int. 2013 Aug;112(4):E314-20. doi: 10.1111/j.1464-410X.2012.11493.x. Epub 2013 Mar 4. PMID: 23451984.(*)
  • Referans11. Mitropoulos D, Artibani W, Biyani CS, Bjerggaard Jensen J, Rouprêt M, Truss M. Validation of the Clavien-Dindo Grading System in Urology by the European Association of Urology Guidelines Ad Hoc Panel. Eur Urol Focus. 2018 Jul;4(4):608-613. doi: 10.1016/j.euf.2017.02.014. Epub 2017 Mar 7. PMID: 28753862.
  • Referans12. Pierorazio PM, Guzzo TJ, Han M, Bivalacqua TJ, Epstein JI, Schaeffer EM, et al. Long-term survival after radical prostatectomy for men with high Gleason sum in pathologic specimen. Urology. 2010 Sep;76(3):715-21. doi: 10.1016/j.urology.2009.11.085. Epub 2010 Mar 29. PMID: 20350749; PMCID: PMC2897964.
  • Referans13. Ischia J, Gleave M. Radical prostatectomy in high-risk prostate cancer. Int J Urol. 2013 Mar;20(3):290-300. doi: 10.1111/iju.12069. Epub 2013 Jan 10. PMID: 23305529.
  • Referans14. Cooperberg MR, Vickers AJ, Broering JM, Carroll PR. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010 Nov 15;116(22):5226-34. doi: 10.1002/cncr.25456. Erratum in: Cancer. 2011 Jun 15;117(12):2825. PMID: 20690197; PMCID: PMC2975879.
  • Referans15. Yuh B, Artibani W, Heidenreich A, Kimm S, Menon M, Novara G, et al. The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in the management of high-risk prostate cancer: a systematic review. Eur Urol. 2014 May;65(5):918-27. doi: 10.1016/j.eururo.2013.05.026. Epub 2013 May 18. PMID: 23721959.
  • Referans16. Harty NJ, Kozinn SI, Canes D, Sorcini A, Moinzadeh A. Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy. Int Braz J Urol. 2013 Sep-Oct;39(5):639-46; discussion 647-8. doi: 10.1590/S1677-5538.IBJU.2013.05.05. PMID: 24267107.
  • Referans17. Boorjian SA, Blute ML. Surgical management of high risk prostate cancer: the Mayo Clinic experience. Urol Oncol. 2008 Sep-Oct;26(5):530-2. doi: 10.1016/j.urolonc.2008.03.009. PMID: 18774468.
  • Referans18. Yossepowitch O, Eastham JA. Role of radical prostatectomy in the treatment of high-risk prostate cancer. Curr Urol Rep. 2008 May;9(3):203-10. doi: 10.1007/s11934-008-0036-x. PMID: 18765114.
  • Referans19. Gandaglia G, Abdollah F, Hu J, Kim S, Briganti A, Sammon JD, et al. Is robot-assisted radical prostatectomy safe in men with high-risk prostate cancer? Assessment of perioperative outcomes, positive surgical margins, and use of additional cancer treatments. J Endourol. 2014 Jul;28(7):784-91. doi: 10.1089/end.2013.0774. Epub 2014 Mar 24. PMID: 24499306.(*)
  • Referans20. Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, et al. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol. 2012 Apr;61(4):679-85. doi: 10.1016/j.eururo.2011.12.027. Epub 2011 Dec 22. PMID: 22206800.
  • Referans21. Shapiro EY, Scarberry K, Patel T, Bergman A, Ahn JJ, Sahi N, et al. Comparison of robot-assisted and open retropubic radical prostatectomy for risk of biochemical progression in men with positive surgical margins. J Endourol. 2014 Feb;28(2):208-13. doi: 10.1089/end.2013.0393. Epub 2013 Nov 9. PMID: 24044423.
  • Referans22. Ritch CR, You C, May AT, Herrell SD, Clark PE, Penson DF, et al. Biochemical recurrence-free survival after robotic-assisted laparoscopic vs open radical prostatectomy for intermediate- and high-risk prostate cancer. Urology. 2014 Jun;83(6):1309-15. doi: 10.1016/j.urology.2014.02.023. Epub 2014 Apr 18. PMID: 24746665.
  • Referans23. Lee D, Choi SK, Park J, Shim M, Kim A, Lee S, et al. Comparative analysis of oncologic outcomes for open vs. robot-assisted radical prostatectomy in high-risk prostate cancer. Korean J Urol. 2015 Aug;56(8):572-9. doi: 10.4111/kju.2015.56.8.572. Epub 2015 Jul 29. PMID: 26279826; PMCID: PMC4534431.(*)
  • Referans24. Van Poppel H, Vekemans K, Da Pozzo L, Bono A, Kliment J, Montironi R, et al. Radical prostatectomy for locally advanced prostate cancer: results of a feasibility study (EORTC 30001). Eur J Cancer. 2006 May;42(8):1062-7. doi: 10.1016/j.ejca.2005.11.030. Epub 2006 Apr 18. PMID: 16624554.
  • Referans25. Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016 Sep 10;388(10049):1057-1066. doi: 10.1016/S0140-6736(16)30592-X. Epub 2016 Jul 26. Erratum in: Lancet. 2017 Apr 8;389(10077):e5. PMID: 27474375.(*)
  • Referans26. Coughlin GD, Yaxley JW, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol. 2018 Aug;19(8):1051-1060. doi: 10.1016/S1470-2045(18)30357-7. Epub 2018 Jul 17. PMID: 30017351.(**)
  • Referans27. Haglind E, Carlsson S, Stranne J, Wallerstedt A, Wilderäng U, Thorsteinsdottir T, et al; LAPPRO steering committee. Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial. Eur Urol. 2015 Aug;68(2):216-25. doi: 10.1016/j.eururo.2015.02.029. Epub 2015 Mar 12. PMID: 25770484.(*)
  • Referans28. Cao L, Yang Z, Qi L, Chen M. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine (Baltimore). 2019 May;98(22):e15770. doi: 10.1097/MD.0000000000015770. PMID: 31145297; PMCID: PMC6709105.
  • Referans29. Haese A, Knipper S, Isbarn H, Heinzer H, Tilki D, Salomon G, et al. A comparative study of robot-assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures. BJU Int. 2019 Jun;123(6):1031-1040. doi: 10.1111/bju.14760. Epub 2019 Apr 12. PMID: 30927303.(*)
  • Referans30. Pompe RS, Karakiewicz PI, Tian Z, Mandel P, Steuber T, Schlomm T, et al. Oncologic and Functional Outcomes after Radical Prostatectomy for High or Very High Risk Prostate Cancer: European Validation of the Current NCCN® Guideline. J Urol. 2017 Aug;198(2):354-361. doi: 10.1016/j.juro.2017.02.070. Epub 2017 Feb 16. PMID: 28216329.(*)
Endoüroloji Bülteni-Cover
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 2020
  • Yayıncı: ENDOÜROLOJİ DERNEĞİ
Arşiv
Sayıdaki Diğer Makaleler

Klinik yan dal eğitimi sonrası laparoskopik donör nefrektomide ilk deneyimler

Mehmet ALTAN, Anar AGHAYEV, Alihan KOKURCAN, Sanem CİMEN, Sertaç ÇİMEN, Hasan Nedim Göksel GÖKTUĞ

Yüksek riskli prostat kanserli hastalarda açık retropubik ve robot yardımlı radikal prostatektominin onkolojik ve fonksiyonel sonuçları

Furkan ŞENDOĞAN, Volkan TUĞCU, Turgay TURAN, Selçuk ŞAHİN, Özgür EFİLOĞLU, Asıf YILDIRIM

Böbrek taşı tedavisinde fleksibl üreterorenoskopi ile lazer litotripsi sonrası enfektif komplikasyonları etkileyen faktörler

Feyzullah ÇELİK, Şaban DEMİRDÖĞEN, Şenol ADANUR

Retrograd İntrarenal Cerrahi sonrası taşsızlık değerlendirilmesinde üç skorlama sisteminin karşılaştırılması

Ahmet TAHRA, Erdem ZENGİN, Resul SOBAY, Eyüp KÜÇÜK

Koronavirüs pandemisinin laparoskopik ürolojik cerrahi üzerine etkisi

Alihan KOKURCAN, Mehmet Çağlar ÇAKICI, Ferhat KESER, Uygar MİÇOOĞULLARİ, Mehmet ALTAN, Erdem KISA, Nihat KARAKOYUNLU, Gokhan ATİS, Asıf YILDIRIM

Üreteroskopik litotripsi sonrası yerleştirilen double-J stentteki kolonizasyonun klinik önemi göz ardı edilir mi?

Mehmet Çağlar ÇAKICI, Ferhat KESER, Meftun ÇULPAN, Özgür EFİLOĞLU, Uygar MİÇOOĞULLARİ, Ahmet TAHRA, Asıf YILDIRIM