Cancer - Prostate(구연) (NP-027)

로봇 보조 후복막 전립선 절제술의 단일 술자 2000례 경험에 대한 정리
연세대학교 의과대학 신촌 세브란스 병원 비뇨의학교실
이종수, 고동훈, 고혁준, 김민석, 정두용, 장원식, 최영득
Introduction & Objective : To describe our experience and evaluate peri-operative outcomes of over 2000 cases of retroperitoneal robot assisted laparoscopic prostatectomy (RALP) done by single surgeon.

Methods : This retrospective study examined and collected data from electronic medical record for 2,393 cases of retroperitoneal robot assisted laparoscopic prostatectomy done by single surgeon between January 2006 and February 2017. After exclusion of patients who medical records were not fully affordable, Patients of 1,930 were included in the final analysis and were dived into two groups according to the order of surgery, 1) Case 1~965 (February 2010 to January 2014), 2) Case 966~1930 (February 2014 to February 2017). Patients age, BMI, pathological T staging, pre-operation PSA, prostate volume, estimated blood loss (EBL), console time, positive surgical margin, post-operative blood drainage and hospital stay after surgery were evaluated.

Results : The median age of the patients was 65 (59.00-70.00, p = 0.840) and there was no difference between the groups. BMI, pre-operative PSA, prostate volume, estimated blood loss, and hospital stay after surgery were also not significantly different between the groups (p = 0.140, 0.311, 0.169, 0.071 and 0.333, respectively). On the other hand, console time (median [IQR], 54 [46-66] vs. 39 [33-49] p < 0.001) and post-operative blood drainage (427.36 ± 187.45 vs. 319.28 ± 192.42, p 2 = 0.214 and Pearson-0.266, p 2 = 0.71, respectively). The patients between groups, stage pT2 or less increased from 45% to 61%, while patients with stage pT3 or greater decreased from 54% to 39%. Gleason score 6 decreased from 27% to 18%, Gleason score 7 was not significantly different from, but Gleason higher than 8 has been increased from 22% to 32%. The positive surgical margin decreased from 48% to 38% and the 1-year biochemical recurrence rate decreased from 40% to 26%.

Conclusions : It is in the era of increasing prevalence of prostate cancer due to the westernized eating habits of Korean population. The development of PSA accelerated the detection of prostate cancer, but with the increasing Gleason score growth of robotic cases in Korea will lead RALP to be a safe choice for patient treatment with favorable outcomes. However functional evaluation must be followed in the future.
keywords : Prostatectomies; Remote Operations (Robotics); Assessment, Outcomes

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