Background: The advantage of a robotic-assisted (RARP) over a laparoscopic (LRP) approach in radical prostatectomy (RP) remains to be demonstrated.Aim: The aim of the study is to use a homogeneous population in real life and single primary surgeon surgery to analyze the oncological and functional results based on the type of surgical approach and pathological features.Methods: This is a prospective trial on non-metastatic prostate cancer (PCa) patients considered after a multidisciplinary decision to conduct a RP, using a RARP or LRP approach. A real-life setting was analyzed at our Urological Departments using homogeneous criteria for the management of PCa cases and a single surgeon experience on 444 cases (284 LRP and 160 RARP).Results: Mean operating time was significantly lower in RARP (153.21 ± 25.1 min) than in LRP (173.33 ± 44.3 min) (p< 0.001). In cases submitted to an extended lymph node dissection (eLND), the mean number of lymph nodes removed was 15.16 ± 7.83 and 19.83 ± 4.78, respectively, in LRP and RARP procedures (p< 0.001), but positive lymph nodes (pN1) were similarly found in 15.8% of LRP patients and 13.6% of RARP patients (p= 0.430). Surgical margins (SM) positivity was not significantly higher in the RARP group (20.0%) when compared to the LRP group (15.9%) (p= 0.145). During the postoperative follow-up, a biochemical recurrence (BCR) was detected in 14.4% and 7.5% of cases in the LRP and RARP group, respectively, (p= 0.014). Better results of PAD tests at 3-month intervals using the RARP approach (mean pad weight 75.57 ± 122 g and 14 ± 42 g, respectively, in LRP and RARP (p< 0.01)) were described.Conclusions: In the comparison between the RARP and LRP approach, a clear advantage of the robotic approach is a significant reduction in operating times, days of hospitalization, and postoperative catheterization compared to laparoscopic surgery. It is not possible to describe any certain oncological advantage both in terms of surgical margins and pathological lymph nodes removed. In RARP cases a reduction to the limit of significance is described in terms of biochemical recurrence. RARP produces a more rapid recovery of urinary continence at 3 months postoperatively without significant advantages in terms of erective potency recovery.
背景：机器人辅助根治性前列腺切除术（RARP）相较于腹腔镜根治性前列腺切除术（LRP）的优势仍有待证实。目的：本研究旨在通过真实世界中的同质化患者群体及单一主刀医师的手术数据，分析不同手术方式及病理特征对肿瘤学及功能学结果的影响。方法：本研究为前瞻性试验，纳入经多学科讨论后决定接受根治性前列腺切除术的非转移性前列腺癌患者，手术方式为RARP或LRP。我们在泌尿外科科室的真实临床环境中进行分析，采用统一的前列腺癌病例管理标准，并由单一外科医师完成444例手术（其中LRP 284例，RARP 160例）。结果：RARP组平均手术时间（153.21 ± 25.1分钟）显著短于LRP组（173.33 ± 44.3分钟）（p < 0.001）。在接受扩大淋巴结清扫术（eLND）的病例中，LRP与RARP组平均切除淋巴结数量分别为15.16 ± 7.83枚和19.83 ± 4.78枚（p < 0.001），但两组淋巴结阳性（pN1）检出率相似（LRP组15.8% vs RARP组13.6%，p = 0.430）。RARP组手术切缘阳性率（20.0%）与LRP组（15.9%）无显著差异（p = 0.145）。术后随访期间，LRP组与RARP组生化复发率分别为14.4%和7.5%（p = 0.014）。采用RARP术式的患者术后3个月尿垫试验结果更优（LRP组与RARP组平均尿垫重量分别为75.57 ± 122克和14 ± 42克，p < 0.01）。结论：在RARP与LRP的对比中，机器人手术的明确优势在于能显著缩短手术时间、住院天数及术后导尿时间。在手术切缘状态及淋巴结清扫的肿瘤学效果方面，未发现明确的优势。RARP组生化复发率呈现临界显著性降低。RARP术后3个月尿控功能恢复更快，但在勃起功能恢复方面无显著优势。
肿瘤(癌症)患者之家