Background

Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable.

Objective

To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping.

Design, setting, and participants

In a prospective nonrandomised trial, we recruited 2545 men with prostate cancer from seven open (n = 753) and seven robot-assisted (n = 1792) Swedish centres (2008–2011).

Outcome measurements and statistical analysis

Clinometrically-validated questionnaire-based patient-reported erectile function was collected before, 3 mo, 12 mo, and 24 mo after surgery. Surgeon-reported degree of neurovascular-bundle preservation, pathologist-reported positive surgical margin (PSM) rates, and 2-yr prostate-specific antigen-relapse rates were measured.

Results and limitations

Among 1702 preoperatively potent men, we found enhanced erectile function recovery for low/intermediate-risk patients in the robot-assisted group at 3 mo. For patients with high-risk tumours, point estimates for erectile function recovery at 24 mo favoured the open surgery group. The degree of neurovascular bundle preservation and erectile function recovery were greater correlated for robot-assisted surgery. In pT2 tumours, 10% versus 17% PSM rates were observed for open and robot-assisted surgery, respectively; corresponding rates for pT3 tumours were 48% and 33%. These differences were associated with biochemical recurrence in pT3 but not pT2 disease. The study is limited by its nonrandomised design and relatively short follow-up.

Conclusions

Earlier recovery of erectile function in the robot-assisted surgery group in lower-risk patients is counterbalanced by lower PSM rates for open surgeons in organ-confined disease; thus, both open and robotic surgeons need to consider this trade-off when determining the plane of surgical dissection. Robot-assisted surgery also facilitates easier identification of nerve preservation planes during radical prostatectomy as well as wider dissection for pT3 cases.

Patient summary

For prostate cancer surgery, an open operation reduces erection problems in high-risk cancers but has higher relapse rates than robotic surgery. Relapse rates appear similar in low/intermediate-risk cancers and the robot appears better at preserving erections in these cases.

中文翻译：

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开放耻骨后和机器人辅助根治性前列腺切除术后的勃起功能和肿瘤学结果：LAParoscopic前列腺切除术机器人开放试验的结果

背景

与前列腺癌手术中的开放式手术相比，外科医生使用机器人辅助的腹腔镜检查技术是否表现更好。

客观的

报告两种手术方式的勃起功能和早期肿瘤学结果，并按前列腺癌风险分组进行分层。

设计，设置和参与者

在一项前瞻性非随机试验中，我们从七个 瑞典开放中心（n  = 753）和七个机器人辅助中心（n = 1792）（2008-2011年）招募了2545名前列腺癌患者。

成果测量和统计分析

在手术前，手术后3 mo，12 mo和24 mo，收集经临床计量学验证的基于问卷的患者报告的勃起功能。测量了外科医生报告的神经血管束保存程度，病理学家报告的阳性手术切缘（PSM）率和2年前列腺特异性抗原复发率。

结果与局限性

在1702名术前有力的男性中，我们在3个月的机器人辅助组中发现了低/中危患者的勃起功能恢复得到增强。对于高危肿瘤患者，在24 mo时勃起功能恢复的点估计值有利于开放手术组。机器人辅助手术的神经血管束保存程度与勃起功能恢复程度之间存在较大的相关性。在pT2肿瘤中，开放式和机器人辅助手术的PSM发生率分别为10％和17％。pT3肿瘤的相应发生率分别为48％和33％。这些差异与pT3的生化复发有关，但与pT2疾病无关。该研究受到其非随机设计和相对较短的随访的限制。

结论

在低风险患者中，机器人辅助手术组的勃起功能恢复较早，而器官狭窄疾病的开放外科医师降低了PSM率，从而抵消了这种情况。因此，在确定手术解剖平面时，开放式和机械式外科医生都需要考虑这一折衷。机器人辅助手术还有助于在前列腺癌根治术中更容易地识别神经保留平面，并能对pT3病例进行更广泛的解剖。

病人总结

对于前列腺癌手术，开放式手术可减少高危癌症中的勃起问题，但复发率高于机器人手术。在低/中度风险的癌症中，复发率似乎相似，在这些情况下，机器人在保持勃起方面表现得更好。