Functional and ongological results of radical perineal prostatectomy for the management of clinically locally advanced prostate cancer. Single centre experience

Athanasios Ι. Archodakis, Stefanos Bolometes

Abstract


Introduction
Radical prostatectomy is considered to be the best choice for managing localized prostate cancer. There is increased evidence that a surgical approach has an important role to play as a method of treatment for locally advanced prostate cancer. According to the European Association of Urology (EAU), radical prostatectomy is an option for properly chosen patients with locally advanced prostate cancer. The aim of our study is to evaluate the oncological and functional results of radical perineal prostatectomy for the management of patients with clinically locally advanced prostate cancer.

Methods
Between 1993 and 2012, 627 patients underwent radical perineal prostatectomy for histologically confirmed prostate cancer. Eighty three out of 627 patients had clinically advanced disease. Perioperative morbidity, functional results and early oncological outcomes were examined and compared between the two groups.

Results
There was no statistically significant difference between the two groups regarding operation time, intraoperative blood loss, length of hospital stay and duration of catheterization. The rate of complications was also similar, with the exception of two rectal injuries in the locally advanced group, though these were successfully repaired at the same time. In the locally advanced group, 17.3% of the clinically advanced patients had pathologically confined disease. Out of the patients  99.8% remained continent and 36.1% remained potent in the locally advanced group. In the organ confined group the rates were 100% and 62.5%, respectively. Between the two groups there was no significant difference regarding the cancer-specific survival rate.

Conclusion
Radical perineal prostatectomy is considered to be the best choice for treating locally advanced disease, provided patients are fully informed and that they consent to undergo this treatment.

 

Λειτουργικά και ογκολογικά αποτελέσματα της ριζικής περινεϊκής προστατεκτομής στην αντιμετώπιση του κλινικά προχωρημένου τοπικά καρκίνου προστάτη. Η Εμπειρία της ουρολογικής κλινικής του 401 ΓΣΝΑ

Εισαγωγή. Η ριζική προστατεκτομή θεωρείται ως η θεραπεία εκλογής στον εντοπισμένο καρκίνο του προστάτη. Τα τελευταία χρόνια πληθαίνουν οι βιβλιογραφικές αναφορές που υποστηρίζουν πως η χειρουργική αντιμετώπιση έχει θέση στην αντιμετώπιση της, τοπικά, προχωρημένης νόσου. Σύμφωνα με τις οδηγίες της Ευρωπαϊκής Ουρολο-
γικής Εταιρείας, η ριζική προστατεκτομή θεωρείται προαιρετική (optional) επιλογή σε καλά επιλεγμένους ασθενείς με, τοπικά, προχωρημένη νόσο. Σκοπός της παρούσας εργασίας είναι να αναδείξει τον ρόλο της περινεϊκής
προσπέλασης σε ασθενείς με, τοπικά, προχωρημένο καρκίνο προστάτη.

Υλικό και μέθοδος.  Μεταξύ 1993 και 2012,627 ασθενείς με καρκίνο προστάτη υποβλήθηκαν σε ριζική περινεϊκή προστατεκτομή. Απο τους ασθενείς αυτόυς 83 είχαν κλινικά, τοπικά, προχωρημένη νόσο. Συγκρίναμε τη μετεγχειρητική πορεία και τα πρώιμα ογκολογικά αποτελέσματα μεταξύ των δύο ομάδων.

Αποτελέσματα. Δεν παρατηρήθηκε διαφορά όσον αφορά στο μέσο χειρουργικό χρόνο, την απώλεια αίματος , την παραμονή στο νοσοκομείο και τη διάρκεια καθετηριασμού μεταξύ των δύο ομάδων. Δεν υπήρχε στατιστικά σηαντική διαφορά στις μετεγχειρητικές επιπλοκές και 2 διεγχειρητικές τρώσεις ορθού στην ομάδα της τοπικά προχωρημένης νόσου αποκαταστάθηκαν σε πρώτο χρόνο, επιτυχώς. Στην ομάδα της τοπικά προχωρημένης νόσου υπήρξε παθολογοανατομική υποσταδιοποίηση στο 17,3% των περιπτώσεων. Το 99,8% διατήρησαν την εγκράτεια τους και το 36,1 % την στυτική τους λειτουργία έναντι 100 και 62,5% στην ομάδα της εντοπισμένης νόσου. Δεν υπήρξε στατιστικά σημαντική διαφορά στην ειδική της νόσου επιβίωση μεταξύ των δύο ομάδων.


Keywords


Radical perineal prostatectomy; locally advanced prostate cancer;

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DOI: http://dx.doi.org/10.19264/hj.v26i1.55