A Comparison Research Of Robot-assisted Radical Prostatectomy And Traditional Laparoscopic Radical Prostatectomy

BackgroundProstate cancer is one of the most common malignancies in Europe and the United States,which incidence rate ranks first and mortality rate ranks second.Also it is one of the main causes of male cancer death.The prostate cancer incidence in our country is lower than the developed countries in Europe and America,but with the improvement of living conditions,population aging and the growing popularity of PSA screening,the incidence and mortality rate is continuingly raising in recent years.So far,radical prostatectomy is still the most effective way for the treatment of localized prostate cancer and some high-risk prostate cancer.In the era of minimally invasive surgery,robot-assisted laparoscopic and laparoscopic radical prostatectomy are gradually replacing open radical prostatectomy.In 2000,the German scholar carried out the first robot-assisted radical prostatectomy,while the Chinese PLA general hospital also completed the first robot-assisted radical prostatectomy in October 2007.Currently,a number of domestic hospitals have been introduced da Vinci robot surgery system,its advantages in radical prostatectomy has been recognized by the domestic urology surgeon.ObjectiveTo evaluate the safety and feasibility of clinical application by comparing the curative effect of robot-assisted radical prostatectomy and traditional laparoscopic radical prostatectomy.MethodsFrom September 2014 to September 2016,we completed a total of 165 cases of radical prostatectomy,including robot-assisted radical prostatectomy in 89 cases,the traditional laparoscopic radical prostatectomy in 76 cases.Retrospectively analysis operative time,blood loss,transfusion rate,postoperative bedtime,positive margin,postoperative leakage rate,postoperative drainage time,postoperative hospital stay,postoperative pad-free continence rate at 3,6 and 12 months,biochemical recurrence rate of two surgical methods.The data of the two groups were analyzed by SPSS 19.0 statistical software package.According to different cases,t test and χ2 test were used to analyze the difference.The difference was statistically significant(P <0.05).ResultFrom September 2014 to September 2016,we successfully completed robot-assisted radical prostatectomy 89 cases,no conversion to open operation.The mean operation time was(89±40.7)min(range 54 to 147),and mean blood lose was(178±173.5)ml(range 20 to 600).The mean postoperative activity time was(1.5±0.6)days(range 1 to 3),and mean removal of drainage tube was(7.1±4.9)days(range 2 to 43),and mean hospital stay after surgery was(8.9±4.0)days(range 5 to 29).The positive margin was 18.0%(16/89).Postoperative complications occurred in 9 cases(10.1%),urine leakage in 3 cases,infection in 1 case,intestinal obstruction in 2 cases,urethral stricture in 2 cases,incisional hernia in 1 case,and 8 cases were cured by conservative treatment,1 case cured by hernia repair.During the mean follow-up of(9.8±7.3)months(range 1 to 23),the pad-free continence rate was 86.6%(58/67),92.7%(51/55)and 96.9%(31/32)respectively at 3,6 and 12 months after operation.And 7 patients had biochemical recurrence,1 had multiple metastases and 1 died.From September 2014 to September 2016,we successfully completed traditional laparoscopic radical prostatectomy 76 cases,no conversion to open operation.The mean operation time was(118±79.4)min(range 68 to 213),and mean blood lose was(203.4±199.3)ml(range 10 to 1300).The mean postoperative activity time was(1.7±0.8)days(range 1 to 3),and mean removal of drainage tube was(10.4±8.2)days(range 2 to 51),and mean hospital stay after surgery was(14.2±5.9)days(range 7 to 33).The positive margin was 14.5%(11/76).Postoperative complications occurred in 13 cases(17.1%),urine leakage in 7 cases,intestinal obstruction in 1 case,urethral stricture in 2 cases,deep venous thrombosis in 3 cases,and all cases were cured by conservative treatment.During the mean follow-up of(9.3±7.8)months(range 1 to 23),the pad-free continence rate was 74.2%(46/62),82.6%(38/46)and 89.7%(26/29)respectively at 3,6 and 12 months after operation.And 7 patients had biochemical recurrence.ConclusionsRobot-assisted radical prostatectomy is safe and feasible for patients with prostate cancer,clinical results are satisfactory,and compared with traditional laparoscopic radical prostatectomy,both oncologic and functional results are similar,robot-assisted radical prostatectomy for an easier and faster surgery,quick recovery,earlier removal of drainage tube,shorter hospital stay.