Clinical Analysis Of Robot-assisted Laparoscopic Prostatectomy In The Treatment Of High-risk Prostate Cancer

Background Prostate cancer is one of the most common malignant tumors in elderly men,and its incidence is increasing year by year in China.In 2016,there were 120,000 new prostate cancer patients in China,and it's expected to reach 237,000 by 2030,with a compound annual growth rate of about 5%.Radical prostatectomy is one of the standard treatments for localized prostate cancer,especially for patients with stage T1?T2 c.However,about 35.8% of prostate cancer patients in China have entered the stage of high risk prostate cancer when diagnosed.Currently,treatment strategies for high risk prostate cancer are controversial.Traditional treatment for high risk prostate cancer patients is mainly radiotherapy or endocrine therapy,do not advocate surgery.In recent years,on the one hand,with the in-depth understanding of pelvic floor anatomy,the development of anatomical RP makes the further reduce of surgical complications and survival has been obviously improved,on the other hand,considering the radical prostatectomy' good effect for local control of the tumor,which can also provide accurate tumor grade and stage,surgical treatment at high risk prostate cancer become a hot topic of clinical doctors.With the rapid development of surgical technology,robots have been applied in various fields.In Europe and America,robot-assisted laparoscopic radical prostatectomy is the most widely used robotic surgery in the field of urology,and is gradually replacing the traditional open radical prostatectomy and laparoscopic radical prostatectomy.Recently,more and more urologists at home and abroad have used robot-assisted laparoscopic radical prostatectomy for high risk prostate cancer,and achieved satisfactory results.Objective The purpose of this study was to compare and analyze the efficacy of robot-assisted laparoscopic radical prostatectomy in the treatment of high risk prostate cancer and low-medium-risk prostate cancer,and to evaluate the safety and effectiveness of robot-assisted laparoscopic radical prostatectomy in the treatment of high-risk prostate cancer.Methods We retrospectively analyzed 314 cases of prostate cancer patients,who were operated with robot assisted laparoscopic radical prostatectomy by the same physician in the first affiliated hospital of zhengzhou university from October 2014 to January 2019.According to risk classification of D'Amic,we divided the 314 patients into high risk and low-medium-risk group,and revisit the postoperative urinary control functions and the postoperative biochemical recurrence.SPSS 22.0 statistical software was used for data statistical analysis,and Selecting ANOVA or ?2 test according to data-type.Cox regression model was used to analyze the influencing factors of postoperative urinary control recovery rate and biochemical recurrence by univariate and multivariate analysis.Kaplan-meier method was used for survival analysis.P<0.05 indicated that the difference was statistically significant.Results According to the criteria of selection and exclusion,189 cases were high-risk group and 124 cases were low-medium-risk group.The mean operative time was 101.7±54.84 minutes,the average intraoperative bleeding volume was 121.60±101.53 ml,and the average postoperative hospital stay was 6.67±4.02 days.There was no significant difference between two groups(P >0.05).There was also no significant difference in postoperative complications between two groups.The most common complication was temporary obturator nerve paralysis,followed by urine leakage.The total margin positive rate was 8.0%,with 9.0% in high-risk group and 6.5% in the other,but there was no significant difference(P >0.05).The recovery rates of urine control after 3 months' operation in high-risk group and the other were 66.7% vs 80.3%,and after 6 months' operation were 84.8% vs 93.9%,which means the recovery rate in high-risk group was lower than that the other group(P<0.05).Howere,there was no significant difference in the recovery rate of urine control between 1 month and 12 months after operation(P = 0.454,P = 0.271).The 3-month biochemical recurrence rates in high-risk group and low-medium-risk group were 2.7% vs 1.6%,the 6-month were 8.2% vs 4.9%,the 12-month were 16.7 vs 7.2%,the 24-month were 31.5% vs 22.1%.The biochemical recurrence rates of 6 months,12 months and 24 months after operation were significantly different between the two groups(P < 0.05).Conclusions 1.Although there are oncology differences in prostate cancer patients with different risk levels,with the support of robotic surgical platforms,robot assisted laparoscopic radical prostatectomy for high risk prostate cancer can achieve similar surgical results as low-middle-risk prostate cancer patients.It can be used as the first choice for the treatment of prostate cancer at high risk.2.In the treatment of high risk prostate cancer,if the experienced physicians select the patients well and operat carefully during the operation to control the positive margin of incision,patients can improve postoperative urine control recovery rate,and obtain better oncology results.3.Despite the unique advantages of robot assisted laparoscopic prostatectomy in the treatment of high risk prostate cancer,the postoperative biochemical recurrence is still higher than low-middle-risk prostate cancer.