Clinical Study Of Davinci Robotic Surgery System In Application Of Prostate Cancer Operation

The study aimed to study the clinical application of Davinci robotic surgery system in the treatment of prostate cancer in China.Part I: Long-term cancer control outcomes of robot-assisted radical prostatectomy for the treatment of prostate cancer: a Meta-analysisObjectives: The present study aimed to evaluate its long-term cancer control outcomes, which were limited and inconsistent among the previous evidences. Method:Medline, Scopus, and et al. were searched for studies published during January 2010 to July 2016. Meta-analyses of case series and prospective cohort studies regarding the long-term cancer control outcomes of patients undergoing RALP were performed by R statistical software. The data of 5- and 10-year biochemical recurrence free survival(BCRFS) and cancer specific survival (CSS) were extracted from the included studies to assess these outcomes. Results: Twenty studies involved in RALP with more than 5 years’follow up were included. The pooled proportions of the 5-year BCRFS and CSS resulted from 20 and 4 studies were 80% and 97% in RALP therapy, respectively. Conclusion: The meta-analysis of long-term cancer control outcomes demonstrated that RALP has satisfactory long-term BRFS and CSS. Further, the RALP seems to have more survival advantages than ORP.Part II: Clinical outcomes of Davinci robot-assisted radical prostatectomy for the treatment of prostate cancerObjectives:To study the clinical outcomes of Davinci robot-assisted radical prostatectomy for the treatment of prostate cancer. Method:We retrospectively reviewed the clinical and follow-up data of 948 patients who underwent the operations in The People’s Liberation Army General Hospital during 2008-2015,673 cases were underwent the RALP with Davinci system,275 cases were underwent the laparoscopic radical prostatectomy. Results: The RALP group has fewer average drainage tube indwelling time.The differences of median age、BMI、estimated blood loss、positive surgical margin in both groups were all not statistically significant. High-risk cases had more estimated blood loss and complications.Conclusion: RALP can provide safely perioprative datas,oncological control,recovery of postoperative continence.Part III: The learning curve of Davinci robot-assisted radical prostatectomyObjectives:To research the learning curve of Davinci robot-assisted radical prostatectomy of single operator. Method:We retrospectively reviewed the clinical and follow-up datas of 4 groups patients(597 cases) who underwent the operations in The People’s Liberation Army General Hospital during 2008-2015 with Davinci system, to explore the learning curve of single operator. Results: After the operator accomplished 150 cases RALP,the estimated blood loss、complications became decreased,and the functional outcomes became better than before. Conclusion:The learning curve of Davinci robot-assisted radical prostatectomy was nearly 150 cases.Part IV: The risk factors for Gleason system upgrading and downgrading of prostate cancer from biopsy to robot-assisted radical prostatectomyObjectives:To research the risk factors for Gleason system upgrading and downgrading of prostate cancer from biopsy to robot-assisted radical prostatectomy.Method: We retrospectively reviewed 3 groups patients(351 cases) who underwent the operations in The People’s Liberation Army General Hospital during 2008-2015 with Davinci system, to explore the risk factors for upgrading and downgrading of prostate cancer from biopsy to robot-assisted radical prostatectomy. Results: The differences of median age、BMI、the level of PSA among the three groups were all not statistically significant、Prostate volume、the primary grade pattern and the secondary grade pattern≥4 were the risk factors for upgrading and downgrading of prostate cancer from biopsy to RALP. Conclusion:Upgrading and downgrading of prostate cancer from biopsy to robot-assisted radical prostatectomy including:prostate volume、the primary grade pattern and the secondary grade pattern≥4.