开放与腹腔镜下根治性前列腺切除术治疗局限和局部高危前列腺癌的对比研究

Comparison of oncologic and functional outcomes by retropubic and laparoscopic radical prostatectomy for the treatment of localized and locally advanced prostate cancer

目的 比较开放式耻骨后根治性前列腺切除术（retropubic radical prostatectomy,RRP）和腹腔镜下根治性前列腺切除术（laparoscopic radical prostatectomy,LRP）治疗局限性和局部高危前列腺癌的控瘤效果和术后功能恢复情况.方法 回顾性分析2000年10月至2013年12月行根治性前列腺切除术的729例前列腺癌患者的临床资料,其中RRP组164例,年龄38～ 84岁,中位年龄69岁,中位随访时间58个月;LRP组565例,年龄39～ 88岁,中位年龄69岁,中位随访时间66个月.根据术后病理分期将患者分为局限性和局部高危前列腺癌.RRP与LRP组局限性前列腺癌分别为78和370例,局部高危前列腺癌分别为86和195例.比较局限性和局部高危前列腺癌在RRP组和LRP组之间的切缘阳性率、1年控尿率、2年控尿率、勃起功能恢复率、5年无生化复发生存率和5年肿瘤特异性生存率.结果 RRP与LRP组局限性患者的切缘阳性率分别为11.5％和13.8％,局部高危患者分别为31.4％和32.8％;5年无生化复发生存率分别为79.7％与85.6％,46.8％与50.6％;5年肿瘤特异性生存率为97.8％与98.8％,85.3％与91.2％;RRP与LRP组间比较差异均无统计学意义（P＞0.05）.RRP与LRP组局限性前列腺癌患者的1年控尿率分别为87.2％与92.7％,2年控尿率分别为97.4％与96.5％;局部高危前列腺癌患者的1年控尿率分别为76.7％与85.1％,2年控尿率为88.4％与90.8％;RRP与LRP组间比较差异均无统计学意义（P＞0.05）.RRP与LRP组局限性前列腺癌患者的勃起恢复率分别为42.6％与59.0％,差异有统计学意义（P=0.03）.结论 LRP与RRP治疗局限性前列腺癌和局部高危前列腺癌总体控瘤效果满意,术后控尿功能恢复情况相近,LRP在局限性前列腺患者术后勃起功能恢复上具有一定优势.

Objective To compare the oncologic and functional outcomes of retropubic radical prostatectomy （RRP） and laparoscopic radical prostatectomy （LRP） for the treatment of localized and locally advanced prostate cancer （PCa）.Methods From October 2000 to December 2013,729 PCa cases who underwent radical prostatectomy were retrospectively analyzed.Of the 729 patients,164 cases underwent RRP while 565 cases conducted LRP.The median age in RRP and LRP groups was 69 （38-84） years and 69 （39-88） years,median follow-up time was 58 （18-153） months and 66 （19-174） months,respectively.All the cases were stratified into localized （RRP 78 cases,LRP 370 cases） and locally advanced （RRP 86,LRP 195） PCa according to pathological TNM stage.Positive surgical margins （PSM）,1-and 2-year urinary continence,potency,5-year biochemical recurrence-free survival and 5-year cancer-specific survival were recorded and analyzed between RRP and LRP groups.Results In localized and locally advanced cases between the 2 groups （RRP versus LRP）,PSM rates were 11.5% versus 13.8%,31.4% versus 32.8%,5-year biochemical recurrence free rates were 79.7% versus 85.6%,46.8% versus 50.6%,and 5-year cancer-specific survival rates were 97.8% versus 98.8%,85.3% versus 91.2%.There was no significant difference between RRP and LRP groups （P 〉0.05）.The 1-and 2-year urinary continence rates （RRP versus LRP） in localized PCa were 87.2% versus 92.7%,97.4% versus 96.5%,respectively （P 〉 0.05）.The 1-and 2-year urinary continence rates （RRP versus LRP） in locally advanced PCa were 76.7% versus 85.1%,88.4% versus 90.8%,respectively （P 〉 0.05）.The difference was significantly observed regarding potency between RRP and LRP groups （42.6% versus 59.0%,P 〈 0.05） in patients with localized PCa.Conclusions The oncological and functional outcomes between RRP and LRP are comparable both in localized and locally advanced PCa.LRP had advantage on erectile functional recovery over RRP.