Taner KARGI, Alper BİTKİN, Ubeyd SUNGUR, Serdar KARADAĞ, İsmail EVREN, Ahmet HACİİSLAMOĞLU, Hakan POLAT, Necati GÜRBÜZ, Volkan TUĞCU, Ali İhsan TAŞÇI

Büyük prostat hacminin robotik radikal prostatektomi sonrası perioperatif, onkolojik ve fonksiyonel sonuçlar üzerine etkisi: Retrospektif klinik çalışma

Amaç: Bu çalışmada büyük prostat volümünün Robot yardımlı radikal prostatektomi (RARP) uygulanan prostat kanserli hastalarda cerrahi, onkolojik ve fonksiyonel sonuçlara etkisinin değerlendirilmesini amaçladık. Gereç ve Yöntemler: Bu çalışmada prostat kanseri nedeniyle tek cerrah tarafından RARP uygulanan hastalar 75 cc’nin üzerinde büyük prostat hacmi (Grup-1) ve 75 cc’nin altında prostat hacmi (Grup-2) olmak üzere iki gruba ayrılmış ve bu iki grup retrospektif olarak karşılaştırılmıştır. Hastalar 12 aylık takip süresince değerlendirildi. Bulgular: Yaş, preoperatif PSA seviyesi, klinik evre dağılımları , Gleason skoru, D’Amico risk sınıflaması, cerrahi öncesinde potens ve kontinans değerlendirmesi açısından iki grup arasında anlamlı fark yoktu (p>0.05). Operasyon süresi grup 1 ve 2’de sırasıyla 169.9 ± 62.5 dakika ve 145.6 ± 56.1 dakika saptandı ve Grup 1’de anlamlı olarak daha yüksekti (p = 0.02). Grup 1 ve 2’de sırasıyla 17 (%35) ve 2 (%3) hastaya mesane boynu rekonstrüksiyonu yapıldı ve grup-1’de istatiksel anlamlı olarak yüksekti (p = 0.001). Grup 1 ve Grup 2’de üretral kateter çıkarıldıktan sonra tam kontinans ve potens oranları 1 yıllık takip süresince benzerdi (p > 0.05). 6. ay ve 1. yılda biyokimyasal nüks oranları Grup 1 ve Grup 2’de benzer izlendi (p > 0.05). Sonuç: Büyük prostat hacmine sahip prostat kanserli hastalarda RARP daha uzun operasyon süresi ile sonuçlanır ve mesane boynu rekonstruksiyonu gerekebilir. Ancak deneyimli cerrahlar tarafından gerçekleştirilen operasyonlarda büyük prostat hacminin cerrahi, fonksiyonel ve onkolojik sonuçlara olumsuz etkisi yoktur.

Anahtar Kelimeler:

Robotik cerrahi işlemler, Prostatektomi, Prostat, Organ Büyüklüğü

Effect of large prostate volume on perioperative, oncological and functional outcomes after robotic radical prostatectomy: A retrospective clinical study

Objective: In this study, we aimed to evaluate the effect of large prostate volume on surgical, oncological and functional outcomes in prostate cancer patients who underwent Robot-assisted radical prostatectomy (RARP). Material and Methods: In this study, patients who underwent RARP due to prostate cancer by a single surgeon were divided into two groups as large prostate volume over 75 cc (Group-1) and prostate volume less than 75 cc (Group-2), and these two groups were compared retrospectively. Patients who were followed up for 12 months were assessed. Results: There was no significant difference between the two groups in terms of age, preoperative PSA level, clinical stage distributions, Gleason score, D’Amico risk classification, preoperative potency and continence assessment (p>0.05). The operative time was 169.9 ± 62.5 minutes and 145.6 ± 56.1 minutes in Groups 1 and 2, respectively, and was significantly higher in Group 1 (p= 0.02). Bladder neck reconstruction was performed in 17 (35%) and 2 (3%) patients in Groups 1 and 2, respectively, and it was statistically significantly higher in Group-1 (p=0.001). After removal of the urethral catheter in Group 1 and Group 2, full continence and potency rates were similar during the 1-year follow-up (p >0.05). Biochemical recurrence rates at 6 months and 1 year were similar in Group 1 and Group 2 (p >0.05). Conclusion: In prostate cancer patients with large prostate volume, RARP results in longer operative time and bladder neck reconstruction may be required.. However, in operations performed by experienced surgeons, large prostate volume does not have a negative effect on surgical, functional and oncological outcomes.

Keywords:

robotic surgical procedures, prostatectomy prostate, organ size, Robotik cerrahi işlemler, Prostatektomi,

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[1] Sung H, Ferlay J, Siegel RL, et al. Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. https://doi.org/10.3322/caac.21660
[2] Culp MB, Soerjomataram I, Efstathiou JA, et al. Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates. Eur Urol. 2020;77(1):38-52. https://doi.org/10.1016/j.eururo.2019.08.005
[3] Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol. 2017;4(3):148-151. https://doi.org/10.1016/j.ajur.2017.06.004
[4] Foley CL, Bott SR, Thomas K, et al. A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates. BJU Int. 2003;92(4):370-4. https://doi.org/10.1046/j.1464-410x.2003.04361.x
[5] Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2021;79(2):243-262. https://doi.org/10.1016/j.eururo.2020.09.042
[6] Freedland SJ, Isaacs WB, Platz EA, et al. Prostate size and risk of high-grade, advanced prostate cancer and biochemical progression after radical prostatectomy: a search database study. J Clin Oncol. 2005;23(30):7546-54. https://doi.org/10.1200/JCO.2005.05.525
[7] Moschini M, Gandaglia G, Suardi N, et al. Importance of prostate volume in the stratification of patients with intermediate-risk prostate cancer. Int J Urol. 2015;22(6):555-61. https://doi.org/10.1111/iju.12748
[8] Skolarus TA, Hedgepeth RC, Zhang Y, et al. Does robotic technology mitigate the challenges of large prostate size? Urology. 2010;76(5):1117-21. https://doi.org/10.1016/j.urology.2010.03.060
[9] Pettus JA, Masterson T, Sokol A, et al. Prostate size is associated with surgical difficulty but not functional outcome at 1 year after radical prostatectomy. J Urol. 2009;182(3):949-55. https://doi.org/10.1016/j.juro.2009.05.029
[10] Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int. 2001;87(4):408-10. https://doi.org/10.1046/j.1464-410x.2001.00115.x
[11] Novara G, Ficarra V, Rosen RC, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):431-52. https://doi.org/10.1016/j.eururo.2012.05.044
[12] Wolfram M, Bräutigam R, Engl T, et al. Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique. World J Urol. 2003;21:128–132. https://doi.org/10.1007/s00345-003-0346-z
[13] Rosen RC, Cappelleri JC, Smith MD, et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319-26. https://doi.org/10.1038/sj.ijir.3900472
[14] Fahmy O, Alhakamy NA, Ahmed OAA, et al. Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis. Cancers (Basel). 2021;13(23):6130. https://doi.org/10.3390/cancers13236130
[15] Min SH, Park YH, Lee SB, et al. Impact of prostate size on pathologic outcomes and prognosis after radical prostatectomy. Korean J Urol. 2012;53(7):463-6. https://doi.org/10.4111/kju.2012.53.7.463
[16] Allaparthi SB, Hoang T, Dhanani NN, et al. Significance of prostate weight on peri and postoperative outcomes of robot assisted laparoscopic extraperitoneal radical prostatectomy. Can J Urol. 2010;17(5):5383-9.
[17] Moschini M, Gandaglia G, Suardi N, et al. Importance of prostate volume in the stratification of patients with intermediate-risk prostate cancer. Int J Urol. 2015;22(6):555-61. https://doi.org/10.1111/iju.12748
[18] Kim MS, Jang WS, Chung DY, et al. Effect of prostate gland weight on the surgical and oncological outcomes of extraperitoneal robot-assisted radical prostatectomy. BMC Urol. 2019;19(1):1. https://doi.org/10.1186/s12894-018-0434-4
[19] Hirasawa Y, Ohno Y, Nakashima J, et al. Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon's experience with robot-assisted radical prostatectomy. Surg Endosc. 2016;30(9):3702-8. https://doi.org/10.1007/s00464-015-4664-1
[20] Zorn KC, Orvieto MA, Mikhail AA, et al. Effect of prostate weight on operative and postoperative outcomes of robotic-assisted laparoscopic prostatectomy. Urology. 2007;69(2):300-5. https://doi.org/10.1016/j.urology.2006.10.021
[21] Yasui T, Tozawa K, Kurokawa S, et al. Impact of prostate weight on perioperative outcomes of robot-assisted laparoscopic prostatectomy with a posterior approach to the seminal vesicle. BMC Urol. 2014;14:6. https://doi.org/10.1186/1471-2490-14-6
[22] Moris L, Gandaglia G, Vilaseca A, et al. Evaluation of Oncological Outcomes and Data Quality in Studies Assessing Nerve-sparing Versus Non-Nerve-sparing Radical Prostatectomy in Nonmetastatic Prostate Cancer: A Systematic Review. Eur Urol Focus. 2021:S2405-4569(21)00161-9. https://doi.org/10.1016/j.euf.2021.05.009
[23] Galfano A, Panarello D, Secco S, et al. Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy? Minerva Urol Nefrol. 2018;70(4):408-413. https://doi.org/10.23736/S0393-2249.18.03069-2