机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术治疗局部进展期前列腺癌的回顾性临床分析

Retrospective study of robotic-assisted laparoscopic radical prostatectomy plus extended pelvic lymph node dissection for locally advanced prostate cancer

目的:评估机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术治疗局部进展期前列腺癌的安全性及其疗效。方法:回顾性分析2015年12月—2019年12月我院收治的112例局部进展期前列腺癌患者的临床资料,放射性核素骨扫描排除骨转移后,行机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术,统计患者手术时间、术中出血量、清扫淋巴结个数、术后病理、住院时间等。结果:112例患者均顺利完成手术,平均手术时间(217.60±30.19)min,平均术中出血量(192.00±138.30)mL,常规术后2周拔除导尿管,平均术后住院时间(9.36±3.42)d。平均检出淋巴结(17.94±4.38)枚,淋巴结转移患者29例,检出阳性淋巴结共107枚,切缘阳性28例,术后淋巴漏21例,平均随访时间(34.69±11.25)个月。术后辅助内分泌治疗61例,放疗32例,出现生化复发44例。结论:局部进展期前列腺癌患者行机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术安全可行,临床疗效满意,并能清除潜在的转移淋巴结,提供精确的肿瘤病理分期,有望改善患者预后。

Objective: To evaluate the feasibility and efficacy of robotic-assisted laparoscopic radical prostatectomy(RARP) plus extended pelvic lymph node dissection(ePLND) for locally advanced prostate cancer. Methods: From December 2015 to December 2019, 112 patients diagnosed with locally advanced prostate cancer and no bone metastasis who underwent RARP+ePLND were enrolled. Clinical characteristics were retrospectively analyzed, including operation time, estimated blood loss, number of lymph nodes dissected, postoperative pathology and length of hospital stay. Results: All patients were successfully completed the operation. The average operation time was(217.60±30.19) min, and the average estimated blood loss was(192.00±138.30) mL. The catheter was removed routinely 2 weeks postoperatively, and the average postoperative length of hospital stay was(9.36±3.42) days. The average lymph nodes detected was(17.94±4.38). There were 29 cases diagnosed with positive lymph node metastasis, and a total of 107 positive lymph nodes were discovered. Twenty-eight cases had a positive resection margin. Lymphatic leakage was found in 21 cases. The average follow-up duration was(34.69±11.25) months. Postoperative adjuvant endocrine therapy and radiotherapy were performed in 61 cases and 32 cases, respectively. Biochemical recurrence was detected in 44 cases. Conclusion: Robotic-assisted laparoscopic radical prostatectomy plus extended pelvic lymph node dissection is a feasible treatment for locally advanced prostate cancer, providing accurate tumor and lymph node pathological staging, as well as clearing potential metastatic lymph nodes.