İbrahim KARABULUT, Fatih Kürşat YILMAZER, Onur CEYLAN

Öğrenme Eğrisinde Median Lob Varlığının Robot Yardımlı Radikal Prostatektomide Onkolojik ve Fonksiyonel Sonuçlar Üzerine Etkisi

Amaç: Robot yardımlı laparaskopik radikal prostatektomi (RALP), öğrenme eğrisinde median lob (ML) varlığının, perioperatif , onkolojik ve fonksiyonel sonuçlar üzerine etkisini araştırmayı amaçladık. Meteryal Metod: Kliniğimizde Temmuz 2017 ile Ekim 2019 tarihleri arasında RALP uygulanan 38 ardışık hastayı analiz ettik. Hastalara ilk öğrenme eğrisinde ki aynı cerrahi ekip tarafından opere edildi. RARP sırasında belirlenen bir ML varlığına veya yokluğuna göre iki grupta analiz edildi. Perioperatif, onkolojik ve fonksiyonel sonuçlar gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya dahil edilen hastaların 10 (% 26,3)’un da prostatik bir ML tespit edildi. Her iki grupta da prostat spesifik antijen (PSA), vücut kitle indeksi(BMI), hastanede kalış süresi , perioperatif ve postoperatif komplikasyon oranları benzerdi(p<0,01). Cerrahi sınır pozitifliği oranı ise ML grubunda %20 (2/10) iken ML’suz grupta %10,7 (3/28) olarak tespit edilidi. Gruplar arası sayısal farklar istatistiksel açıdan anlamlı bulunmadı(p<0,01). Yine de, prostat volümü(p=0,008) ve tahmini kan kaybı(TKK) (p=0,001) median loblu bulunan hastalar lehine anlamlı idi. Ortalama konsol süresi ML'lu hastalarda biraz daha fazla olmasına rağmen bu sayısal farklar istatistiksel açıdan anlamlı bulunmadı(p<0,01). Mesane boynu rekonstruksiyon oranları ML grubunda %100 (%100) iken ML’suz grupta %14 (4/28) olarak ölçüldü(p=0,001). ML olan ve olmayan hastalar arasında kontinans oranları, kateter çıkarılmasından sonra 4. hafta da (% 20 - %35) , 12. hafta da (% 70 -% 64,2) ve 24. hafta da (% 90 -% 89,2) da benzer olup tüm zamanlarda istatistiksel açıdan anlamlı fark gözlenmedi. Sonuç: İlk öğrenme eğrisinde RALP’nin yüksek cerrahi tecrübesi bulunmayan merkezlerde zorlu vakalarda da güvenli ve etkili bir şekilde uygulanabileceğini düşünmekteyiz. Bizim başlangıç serimizde karşılaştığımız ML’lu vakaların ML’suz hastalarla onkolojik, fonksiyonel sonuçları ve komplikasyon oranları karşılaştırıldığında literatür ile uyumlu sonuçlar elde ettik.

Anahtar Kelimeler:

Robot Yardımlı Radikal Prostatektomi, Öğrenme Eğrisi, Prostat ca

The Effect of Median Lobe Presence on Oncologic and Functional Outcomes in Robot Assisted Radical Prostatectomy in the Learning Curve

Objective: We aimed to investigate the effect of the presence of median lobe (ML) in the learning curve on perioperative, oncologic and functional outcomes.Material and Methods: We analyzed 38 consecutive patients undergoing RALP in our clinic between July 2017 and October 2019.Patients were operated by the same surgical team on the first learning curve. They were analyzed in two groups according to the presence or absence of a ML determined during RARP. Perioperative, oncologic and functional results were compared between the groups.Results: Prostatic ML was detected in 10 (26.3%) of the patients included in the study.Prostate specific antigen (PSA), body mass index (BMI), length of hospital stay, perioperative and postoperative complication rates were similar in both groups (p <0.01). Surgical margin positivity rate was 20% (2/10) in the ML group and 10.7% (3/28) in the ML group.Numerical differences between the groups were not statistically significant (p <0.01). Nevertheless, prostate volume (p = 0.008) and estimated blood loss (TCC) (p = 0.001) were significant in favor of patients with median lobes. Although the mean cantilever time was slightly higher in patients with ML, these numerical differences were not statistically significant (p <0.01). Bladder neck reconstruction rates were 100% (100%) in the ML group and 14% (4/28) in the ML-free group (p = 0.001). Continence rates between patients with and without ML were at 4 weeks (20% to 35%) after catheter removal, at 12 weeks (70% to 64.2%) and at 24 weeks (90% to 89.2%). ) and no statistically significant difference was observed at all times.Conclusion: Learning curve, we think that RALP can be applied safely and effectively in challenging cases in centers without high surgical experience. When we compared the oncologic, functional and complication rates of patients without ML in our initial series, we obtained results consistent with the literature.

Keywords:

Robot-assisted radical prostatectomy, learning curve,

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