ABDULLAH ÇIRAKOĞLU, Ahmet YÜCE, ERDAL BENLİ

Asistanlık eğitimi sırasında edinilmeyen Radikal Prostatektomi (RRP) eğitimi için her şey bitmiş midir?

Amaç: Prostat kanseri (PK) erkeklerde çok sık olarak izlenen bir hastalıktır. Bu hastaların tedavisinde, radikal prostatektomi altın standart tedavi yöntemidir. Çoğu zaman asistanlık sürecinde bu eğitim tamamlanamaz. Bu çalışmanın amacı, uzmanlık sonrası dönemde eğitimlerle tamamlanan retropubik radikal prostatektomi (RRP) eğitiminin sonuçlarını sunmak ve bu süreçte edindiğimiz tecrübeyi bu işe yeni başlayacak kişilerle paylaşmaktır. Gereç ve Yöntemler: 2014‐2017 tarihleri arasında kliniğimizde ilk defa yapılan 50 RRP hastasının sonuçları gözden geçirildi. Hasta yaşı, ek hastalıklar, PSA değeri, patoloji sonuçları, dren süresi, hastanede kalma süresi ve komplikasyon gibi özellikleri retrospektif olarak kaydedildi. Bulgular: Ortalama PSA değeri 12.78± 9.76 (3.54-53) ng/dl olarak ölçüldü. Ortalama ameliyat süresi 178.7± 9.7 dakika olarak saptandı. Tahmini kan kaybı 833.3± 121.9 ml (600-1000) ve kan replasmanı 13 (%26) hastada yapıldı. Cerrahi loja yerleştirilen dren ortalama 2.38±1.24 (1-8) günde alındı. Hastanede ortalama kalış süresi ortalama 3.4± 0.9 (2-6) gün olarak saptandı. Hiçbir hastada organ ya da ciddi vasküler yaralanma izlenmedi. Sonuç: Prostat kanseri tedavisinde radikal prostatektomi, mükemmel sonuç, minimal komplikasyon oranları ve başarı ile uygulanmaktadır. Ancak zorluğu ve komplikasyonları nedeniyle çoğu üroloji doktorunun uzak durduğu bir konudur. Bizim çalışma sonuçlarında görüldüğü gibi, yeterince istekli ve gerekli eğitim programlarını tamamlayan kişilerce rahatlıkla uygulanabilir bir yöntem olduğu sonucuna ulaşılmıştır.

Anahtar Kelimeler:

İlk deneyim, rostat kanser, Radikal Retropubik Prostatektomi

Is it over if Radical Prostatectomy (RRP) training is not obtained during assistant education?

Aim: Prostate cancer (PC) is a very common disease in men. Radical prostatectomy is the gold standard method for treatment of these patients. The majority of the time this education cannot be completed during the residency. The aim of this study is to present the results to retropubic radical prostatectomy (RRP) training completed in the period after specialization and to share our experience during this process with those newly starting. Material and Method: The results of 50 rrp patients first attending our clinic from 2014- 2017 were reviewed. Characteristics of the patients like ages, additional diseases, psa values, pathology results, drain duration, hospital stay and complications were retrospectively recorded.Results: Mean PSA value was measured as 12.78± 9.76 (3.54-53) ng/dl. Mean surgical duration was 178.7± 9.7 minutes. Estimated blood loss was 833.3± 121.9 ml (600-1000) and blood replacement was performed for 13 (26%) patients. The mean duration of drain placed in the surgical site was 2.38±1.24 (1-8) days. Mean hospital stay was 3.4± 0.9 (2-6) days. No patient was observed to have organ or serious vascular injury. Conclusion: Radical prostatectomy for prostate cancer treatment is successfully performed with perfect results and minimal complication rates. However, due to difficulties and complications, it is a topic avoided by the majority of urologists. As observed in our study results, it was concluded that this is an easily applied method for individuals with sufficient motivation who have completed the necessary training programs.

Keywords:

first experience, prostate cancer, radical retropubic prostatectomy,

PDF

___

1. Ferlay J, Shin HR, Bray F, et al. Estimates of world wide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127:2893-917.
2. Center MM, Jemal A, Lortet-Tieulent J, et al. International variation in prostate cancer incidence and mortality rates. Eur Urol 2012; 61: 1079-92.
3. Ghagane SC, Nerli RB, Hiremath MB, et al. Incidence of prostate cancer at a single tertiary care center in North Karnataka. Indian J Cancer 2016; 53: 429-431.
4. Finkelstein J, Eckersberger E, Sadri H, et al. Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience. Rev Urol 2010; 12: 35-43.
5. Middleton RG, Thompson IM, Austenfeld MS, Cooner WH, Correa RJ, Gibbons RP, Miller HC, Oesterling JE, Resnick MI, Smalley SR, et al. Prostate Cancer Clinical Guidelines Panel Summary report on the management of clinically localized prostate cancer. The American Urological Association. J Urol 1995; 154: 2144-8.
6. Lee DI. Robotic prostatectomy: what we have learned and where we are going. Yonsei Med J 2009; 50: 177-81.
7. Joseph JV, Leonhardt A, Patel HR. The cost of radical prostatectomy: retrospective comparison of open, laparoscopic, and robot-assisted approaches. J Robot Surg 2008; 2: 21-4.
8. Nelson JB. Debate: Open radical prostatectomy vs laparoscopic vs. robotic. Urol Oncol 2007; 25: 490-3.
9. Ahlering TE, Woo D, Eichel L, et al. Robot assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology 2004; 63: 819-22.
10. Steinberg PL, Merguerian PA, Bihrle W 3rd, Seigne JD. The cost of learning robotic-assisted prostatectomy. Urology 2008; 72: 1068-72.
11. Walsh PC. Anatomic radical prostatectomy: evolution of the surgical technique. J Urol 1998; 160: 2418-24.
12. Rocco B, Matei DV, Melegari S, et al. Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU Int 2009; 104: 991-5.
13. Carlsson S, Nilsson AE, Schumacher MC, et al. Surgeryrelated complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology 2010; 75: 1092-7.
14. Joseph JV, Leonhardt A, Patel HR. The cost of radical prostatectomy: retrospective comparison of open, laparoscopic, and robot-assisted approaches. J Robot Surg 2008; 2: 21-4.
15. Wieder JA, Soloway MS. Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer. J Urol 1998; 160: 299-315.
16. Jaffe J, Castellucci S, Cathelineau X, et al. Robot-assisted laparoscopic prostatectomy: a single-institutions learning curve. Urology 2009; 73: 127-33.
17. Penson DF, McLerran D, Feng Z, et al. 5-year urinary and sexual outcomes after radical prostatectomy: results from the Prostate Cancer Outcomes Study. J Urol 2008; 179: 40-4.
18. Menon M, Hemal AK, Tewari A, et al. The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomy. BJU Int 2004; 93: 715-9.
19. Catalona WJ, Carvalhal GF, Mager DE, et al. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 1999; 162: 433-8.
20. Shah SR, Patel VR: Perioperative outcomes of robotic radical prostatectomy. In: Smith A.J, Tewari A.K, editors. Robotics in urologic surgery. Philadelphia, PA: Saunders Elsevier 2008. p. 91-99.