surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2021-11-4-271-277surgonco-626Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESРоль робот-ассистированной радикальной простатэктомии при раке простаты высокого рискаRobot-Assisted Radical Prostatectomy in High-Risk Prostate Cancerhttps://orcid.org/0000-0003-2125-4897ПавловВ. Н.PavlovV. N.

Павлов Валентин Николаевич — д.м.н., профессор, чл.-кор. РАН, кафедра урологии с курсом ИДПО

Республика Башкортостан, Уфа

Valentin N. Pavlov, D-Dr. Sci. (Med.), Prof., CorrespondingMember of the Russian Academy of Sciences, Departmentof Urology with a course of Advanced Professional Education

Ufa

https://orcid.org/0000-0002-1550-6069ЛогиноваМ. В.LoginovaM. V.

Логинова Мария Владиславовна — онкологическое отделение противоопухолевой лекарственной терапии, кафедра урологиис курсом ИДПО

Республика Башкортостан, Уфа

Maria V. Loginova, Anticancer Drug Therapy Unit, Department of Urology with a course of Advanced Professional Education

Ufa

mariialoginova25@gmail.comhttps://orcid.org/0000-0002-8461-9243ИзмайловА. А.IzmailovA. A.

Измайлов Адель Альбертович — д.м.н., доцент, кафедра урологии с курсом ИДПО

Республика Башкортостан, Уфа

Adel A. Izmailov, Dr.Sci. (Med.), Assoc. Prof., Department of Urology with a course of Advanced Professional Education

Ufa

https://orcid.org/0000-0002-4657-6625УрманцевМ. Ф.UrmantsevM. F.

Урманцев Марат Фаязович — к.м.н., доцент, кафедра урологии с курсом ИДПО, онкологическое отделение

Республика Башкортостан, Уфа

Marat F. Urmantsev, Cand. Sci. (Med.), Assoc. Prof., Department of Urology with a course of Advanced Professional Education, Oncology Department,

Ufa

Башкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian FederationБашкирский государственный медицинский университет; Республиканский клинический онкологический диспансерРоссияBashkir State Medical University; Republican Clinical Oncology DispensaryRussian FederationБашкирский государственный медицинский университет; Клиника Башкирского государственного медицинского университетаРоссияBashkir State Medical University; Clinic of Bashkir State Medical UniversityRussian Federation202121122021114271277Copyright © Павлов В.Н., Логинова М.В., Измайлов А.А., Урманцев М.Ф., 20212021Павлов В.Н., Логинова М.В., Измайлов А.А., Урманцев М.Ф.Pavlov V.N., Loginova M.V., Izmailov A.A., Urmantsev M.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/626Введение

Введение. Рак простаты (РП) разделяют на различные категории риска в зависимости от прогноза заболевания у пациента. Заболевание высокого риска ранее характеризовали повышенным риском метастазирования и летального исхода, что требовало комплексного лечения. Проведя множество исследований, сделали вывод, что хирургия играет ключевую роль в лечении таких случаев, даже в качестве монотерапии. В прошлом у большинства пациентов с РП высокого риска выполнялась открытая радикальная простатэктомия (РПЭ), однако робот-ассистированная радикальная простатэктомия (РАРП) стала разумным вариантом, поскольку она обеспечивает оптимальные результаты для пациентов с РП низкого и промежуточного рисков. Отсутствуют надежные исследования для надлежащей оценки роли РАРП при РП высокого риска. Нами проведен обзор литературы и обобщены данные по функциональным и онкологическим результатам РАРП для лечения пациентов с РП высокого риска, а также проанализированы хирургические результаты лечения пациентов, находившихся на госпитализации в Клинике БГМУ с 2018 по 2021 г.

Материалы и методы

Материалы и методы. Ретроспективно проанализированы хирургические результаты лечения пациентов с РП высокого риска, находившихся на госпитализации в Клинике БГМУ с 2018 по июнь 2021 г. Среди 540 РАРП, выполненных в клинике, у 199 пациентов в соответствии с критериями D’Amico был выявлен РП высокого риска.

Результаты и обсуждение

Результаты и обсуждение. Средняя продолжительность операции составила 100 минут, частота переливания крови — 3,5 %. Время катетеризации мочевого пузыря — 5 дней. Среднее время госпитализации — 7,1 дня.

Заключение

Заключение. РАРП может обеспечивать оптимальную терапевтическую эффективность с преимуществами в послеоперационном восстановлении у пациентов в качестве монотерапии или в качестве первого шага в мультимодальном подходе лечения пациентов с РП высокого риска.

Background

Background. Prostate cancer (PC) is subdivided into risk categories according to patient prognosis. High-risk disease was previously typified by a higher risk of metastasis and mortality, which implied comprehensive treatment. Manifold studies have concluded that surgery is a key measure in such cases, even as monotherapy. Open radical prostatectomy (RP) was routinely performed in most high-risk PC patients until robot-assisted radical prostatectomy (RARP) had become a reasonable choice as improving outcomes in low- and intermediate-risk PC patients. Reliable RARP assessments in high-risk PC are still lacking. Th e review summarises published data on functional and oncological RARP outcomes in high-risk PC patients and analyses surgical inpatient cases at the BSMU Clinic for 2018—2021.

Materials and methods

Materials and methods. The surgical outcomes in high-risk PC inpatients were analysed retrospectively at the BSMU Clinic for 2018—June 2021. Among 540 RARPs performed, 199 PC patients were identified as high-risk in the D’Amico criteria.

Results and discussion

Results and discussion. Mean operation time was 100 min, blood transfusion rate — 3.5 %. Bladder catheterisation time was 5 days, average hospital stay — 7.1 days.

Conclusion

Conclusion. RARP may facilitate optimal therapeutic efficacy and favour postoperative recovery as monotherapy or the first step in a multimodal treatment of high-risk PC patients.

рак простатыпростатэктомияробот-ассистированная радикальная простатэктомияроботизированные хирургические операциифакторы рискабиохимический рецидивпростаты специфическийprostate cancerprostatectomyrobot-assisted radical prostatectomyrobotic surgeryrisk factorsbiochemical recurrenceprostate-specific antigenReferencesYoo S., Lim B., Choi S.Y., You D., Kim C.S. Width of spared neurovascular bundle aft er robot-assisted laparoscopic prostatectomy in patients with prostate cancer: is it a reliable factor for predicting postoperative sexual outcome? Prostate Int. 2021;9(3):119–24. DOI: 10.1016/j. prnil.2020.07.005Yoo S., Lim B., Choi S.Y., You D., Kim C.S. Width of spared neurovascular bundle aft er robot-assisted laparoscopic prostatectomy in patients with prostate cancer: is it a reliable factor for predicting postoperative sexual outcome? Prostate Int. 2021;9(3):119–24. DOI: 10.1016/j. prnil.2020.07.005Clinckaert A., Devos G., Roussel E., Joniau S. Risk stratifi cation tools in prostate cancer, where do we stand? Transl Androl Urol. 2021;10(1):12– 8. DOI: 10.21037/tau-20-1211Clinckaert A., Devos G., Roussel E., Joniau S. Risk stratifi cation tools in prostate cancer, where do we stand? Transl Androl Urol. 2021;10(1):12– 8. DOI: 10.21037/tau-20-1211Fahmy O., Khairul-Asri M.G., Hadi S.H.S.M., Gakis G., Stenzl A. Th e role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis. Urol Int. 2017;99(3):249–56. DOI: 10.1159/000478789Fahmy O., Khairul-Asri M.G., Hadi S.H.S.M., Gakis G., Stenzl A. Th e role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis. Urol Int. 2017;99(3):249–56. DOI: 10.1159/000478789Yaxley J.W., Coughlin G.D., Chambers S.K., Occhipinti S., Samaratunga H., Zajdlewicz L., et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: Early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388(10049):1057– 66. DOI: 10.1016/S0140-6736(16)30592-XYaxley J.W., Coughlin G.D., Chambers S.K., Occhipinti S., Samaratunga H., Zajdlewicz L., et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: Early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388(10049):1057– 66. DOI: 10.1016/S0140-6736(16)30592-XUrkmez A., Ranasinghe W., Davis J.W. Surgical techniques to improve continence recovery aft er robot-assisted radical prostatectomy. Transl Androl Urol. 2020;9(6):3036–48. DOI: 10.21037/tau.2020.03.36Urkmez A., Ranasinghe W., Davis J.W. Surgical techniques to improve continence recovery aft er robot-assisted radical prostatectomy. Transl Androl Urol. 2020;9(6):3036–48. DOI: 10.21037/tau.2020.03.36Aas K., Berge V., Myklebust T.A., Fossa S.D. Comparative survival outcomes of high-risk prostate cancer treated with radical prostatectomy or defi nitive radiotherapy regimens. Eur Urol Open Sci. 2021;26:55–63. DOI: 10.1016/j.euros.2021.01.011Aas K., Berge V., Myklebust T.A., Fossa S.D. Comparative survival outcomes of high-risk prostate cancer treated with radical prostatectomy or defi nitive radiotherapy regimens. Eur Urol Open Sci. 2021;26:55–63. DOI: 10.1016/j.euros.2021.01.011Matsuda Y., Narita S., Okubo T., Mitsuzuka K., Hatakeyama S., Koizumi A., et al. Impact of nerve-sparing status on positive surgical margin location and biochemical recurrence in patients with prostate cancer post radical prostatectomy. Ann Surg Oncol. 2021;28(9):5341–8. DOI: 10.1245/s10434-021-10281-xMatsuda Y., Narita S., Okubo T., Mitsuzuka K., Hatakeyama S., Koizumi A., et al. Impact of nerve-sparing status on positive surgical margin location and biochemical recurrence in patients with prostate cancer post radical prostatectomy. Ann Surg Oncol. 2021;28(9):5341–8. DOI: 10.1245/s10434-021-10281-xCooperberg M.R., Vickers A.J., Broering J.M., Carroll P.R. Comparative risk-adjusted mortality outcomes aft er primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010;116(22):5226–34. DOI: 10.1002/cncr.25456Cooperberg M.R., Vickers A.J., Broering J.M., Carroll P.R. Comparative risk-adjusted mortality outcomes aft er primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010;116(22):5226–34. DOI: 10.1002/cncr.25456Chun S.J., Kim J.H., Ku J.H., Kwak C., Lee E.S., Kim S. Comparison of radical prostatectomy and external beam radiotherapy in high-risk prostate cancer. Radiat Oncol J. 2021;39(3):231–8. DOI: 10.3857/ roj.2021.00486Chun S.J., Kim J.H., Ku J.H., Kwak C., Lee E.S., Kim S. Comparison of radical prostatectomy and external beam radiotherapy in high-risk prostate cancer. Radiat Oncol J. 2021;39(3):231–8. DOI: 10.3857/ roj.2021.00486Calleris G., Marra G., Dalmasso E., Falcone M., Karnes R.J., Morlacco A., et al. Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review. World J Urol. 2019;37(8):1469–83. DOI: 10.1007/s00345-019-02749-zCalleris G., Marra G., Dalmasso E., Falcone M., Karnes R.J., Morlacco A., et al. Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review. World J Urol. 2019;37(8):1469–83. DOI: 10.1007/s00345-019-02749-zGandaglia G., De Lorenzis E., Novara G., Fossati N., De Groote R., Dovey Z., et al. Robot-assisted radical prostatectomy and extended pelvic lymph node dissection in patients with locally-advanced prostate cancer. Eur Urol. 2017;71(2):249–56. DOI: 10.1016/j. eururo.2016.05.008Gandaglia G., De Lorenzis E., Novara G., Fossati N., De Groote R., Dovey Z., et al. Robot-assisted radical prostatectomy and extended pelvic lymph node dissection in patients with locally-advanced prostate cancer. Eur Urol. 2017;71(2):249–56. DOI: 10.1016/j. eururo.2016.05.008McCormick B.Z., Chery L., Chapin B.F. Contemporary outcomes following robotic prostatectomy for locally advanced and metastatic prostate cancer. Transl Androl Urol. 2021;10(5):2178–87. DOI: 10.21037/tau-20-1002McCormick B.Z., Chery L., Chapin B.F. Contemporary outcomes following robotic prostatectomy for locally advanced and metastatic prostate cancer. Transl Androl Urol. 2021;10(5):2178–87. DOI: 10.21037/tau-20-1002Axén E., Godtman R.A., Bjartell A., Carlsson S., Haglind E., Hugosson J., et al. Degree of preservation of neurovascular bundles in radical prostatectomy and recurrence of prostate cancer. Eur Urol Open Sci. 2021;30:25–33. DOI: 10.1016/j.euros.2021.06.005Axén E., Godtman R.A., Bjartell A., Carlsson S., Haglind E., Hugosson J., et al. Degree of preservation of neurovascular bundles in radical prostatectomy and recurrence of prostate cancer. Eur Urol Open Sci. 2021;30:25–33. DOI: 10.1016/j.euros.2021.06.005Yang C.W., Wang H.H., Hassouna M.F., Chand M., Huang W.J.S., Chung H.J. Prediction of a positive surgical margin and biochemical recurrence aft er robot-assisted radical prostatectomy. Sci Rep. 2021;11(1):14329. DOI: 10.1038/s41598-021-93860-yYang C.W., Wang H.H., Hassouna M.F., Chand M., Huang W.J.S., Chung H.J. Prediction of a positive surgical margin and biochemical recurrence aft er robot-assisted radical prostatectomy. Sci Rep. 2021;11(1):14329. DOI: 10.1038/s41598-021-93860-yTakahara K., Sumitomo M., Fukaya K., Jyoudai T., Nishino M., Hikichi M., et al. Clinical and oncological outcomes of robot-assisted radical prostatectomy with nerve sparing vs. non-nerve sparing for high-risk prostate cancer cases. Oncol Lett. 2019;18(4):3896–902. DOI: 10.3892/ol.2019.10692.Takahara K., Sumitomo M., Fukaya K., Jyoudai T., Nishino M., Hikichi M., et al. Clinical and oncological outcomes of robot-assisted radical prostatectomy with nerve sparing vs. non-nerve sparing for high-risk prostate cancer cases. Oncol Lett. 2019;18(4):3896–902. DOI: 10.3892/ol.2019.10692.Walz J., Joniau S., Chun F.K., Isbarn H., Jeldres C., Yossepowitch O., et al. Pathological results and rates of treatment failure in highrisk prostate cancer patients aft er radical prostatectomy. BJU Int. 2011;107(5):765–70. DOI: 10.1111/j.1464-410X.2010.09594.xWalz J., Joniau S., Chun F.K., Isbarn H., Jeldres C., Yossepowitch O., et al. Pathological results and rates of treatment failure in highrisk prostate cancer patients aft er radical prostatectomy. BJU Int. 2011;107(5):765–70. DOI: 10.1111/j.1464-410X.2010.09594.xAbdollah F., Sood A., Sammon J.D., Hsu L., Beyer B., Moschini M., et al. Long-term cancer control outcomes in patients with clinically highrisk prostate cancer treated with robot-assisted radical prostatectomy: Results from a multi-institutional study of 1100 patients. Eur Urol. 2015;68(3):497–505. DOI: 10.1016/j.eururo.2015.06.020Abdollah F., Sood A., Sammon J.D., Hsu L., Beyer B., Moschini M., et al. Long-term cancer control outcomes in patients with clinically highrisk prostate cancer treated with robot-assisted radical prostatectomy: Results from a multi-institutional study of 1100 patients. Eur Urol. 2015;68(3):497–505. DOI: 10.1016/j.eururo.2015.06.020Blecher G., Almekaty K., Kalejaiye O., Minhas S. Does penile rehabilitation have a role in the treatment of erectile dysfunction following radical prostatectomy? F1000Res. 2017;6:1923. DOI: 10.12688/f1000research.12066.1Blecher G., Almekaty K., Kalejaiye O., Minhas S. Does penile rehabilitation have a role in the treatment of erectile dysfunction following radical prostatectomy? F1000Res. 2017;6:1923. DOI: 10.12688/f1000research.12066.1Kishore T.A., Kuriakose M.J., Raveendran V., Ramaprasad M.K. Th e impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis. Indian J Urol. 2021;37(2):140–6. DOI: 10.4103/iju.IJU_414_20Kishore T.A., Kuriakose M.J., Raveendran V., Ramaprasad M.K. Th e impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis. Indian J Urol. 2021;37(2):140–6. DOI: 10.4103/iju.IJU_414_20Jayram G., Decastro G.J., Large M.C., Razmaria A., Zagaja G.P., Shalhav A.L., et al. Robotic radical prostatectomy in patients with high-risk disease: A review of short-term outcomes from a High-Volume Center. J Endourol. 2011;25(3):455–7. DOI: 10.1089/end.2010.0349Jayram G., Decastro G.J., Large M.C., Razmaria A., Zagaja G.P., Shalhav A.L., et al. Robotic radical prostatectomy in patients with high-risk disease: A review of short-term outcomes from a High-Volume Center. J Endourol. 2011;25(3):455–7. DOI: 10.1089/end.2010.0349Schifano N., Capogrosso P., Tutolo M., Dehò F., Montorsi F., Salonia A. How to prevent and manage post-prostatectomy incontinence: a review. World J Mens Health. 2021;39(4):581–97. DOI: 10.5534/wjmh.200114Schifano N., Capogrosso P., Tutolo M., Dehò F., Montorsi F., Salonia A. How to prevent and manage post-prostatectomy incontinence: a review. World J Mens Health. 2021;39(4):581–97. DOI: 10.5534/wjmh.200114Cordes L.M., Schmidt K.T., Peer C.J., Chau C.H., Redmond E., Francis D., et al. Study to compare capsule and liquid formulations of enzalutamide after single-dose administration under fasting conditions in prostate cancer. Oncologist. 2021;26(9):729-e1493. DOI: 10.1002/onco.13919Cordes L.M., Schmidt K.T., Peer C.J., Chau C.H., Redmond E., Francis D., et al. Study to compare capsule and liquid formulations of enzalutamide after single-dose administration under fasting conditions in prostate cancer. Oncologist. 2021;26(9):729-e1493. DOI: 10.1002/onco.13919Nyarangi-Dix J.N., Tosev G., Damgov I., Reimold P., Aksoy C., Hatiboglu G., et al. Recovery of pad-free continence in elderly men does not diff er from younger men undergoing robot-assisted radical prostatectomy for aggressive prostate cancer. World J Urol. 2019;38(2):351–60. DOI: 10.1007/s00345-019-02797-5Nyarangi-Dix J.N., Tosev G., Damgov I., Reimold P., Aksoy C., Hatiboglu G., et al. Recovery of pad-free continence in elderly men does not diff er from younger men undergoing robot-assisted radical prostatectomy for aggressive prostate cancer. World J Urol. 2019;38(2):351–60. DOI: 10.1007/s00345-019-02797-5Yossepowitch O., Eggener S.E., Serio A.M., Carver B.S., Bianco F.J. Jr, Scardino P.T., et al. Secondary therapy, metastatic progression, and cancer-specifi c mortality in men with clinically high-risk prostate cancer treated with radical prostatectomy. Eur Urol. 2008;53(5):950–9. DOI: 10.1016/j.eururo.2007.10.008Yossepowitch O., Eggener S.E., Serio A.M., Carver B.S., Bianco F.J. Jr, Scardino P.T., et al. Secondary therapy, metastatic progression, and cancer-specifi c mortality in men with clinically high-risk prostate cancer treated with radical prostatectomy. Eur Urol. 2008;53(5):950–9. DOI: 10.1016/j.eururo.2007.10.008Nguyen C.T., Reuther A.M., Stephenson A.J., Klein E.A., Jones J.S. Th e specifi c defi nition of high risk prostate cancer has minimal impact on biochemical relapse-free survival. J Urol. 2009;181(1):75–80. DOI: 10.1016/j.juro.2008.09.027Nguyen C.T., Reuther A.M., Stephenson A.J., Klein E.A., Jones J.S. Th e specifi c defi nition of high risk prostate cancer has minimal impact on biochemical relapse-free survival. J Urol. 2009;181(1):75–80. DOI: 10.1016/j.juro.2008.09.027Venclovas Z., Jievaltas M., Milonas D. Signifi cance of time until PSA recurrence aft er radical prostatectomy without neo- or adjuvant treatment to clinical progression and cancer-related death in high-risk prostate cancer patients. Front Oncol. 2019;9:1286. DOI: 10.3389/ fonc.2019.01286Venclovas Z., Jievaltas M., Milonas D. Signifi cance of time until PSA recurrence aft er radical prostatectomy without neo- or adjuvant treatment to clinical progression and cancer-related death in high-risk prostate cancer patients. Front Oncol. 2019;9:1286. DOI: 10.3389/ fonc.2019.01286Stroup S.P., Moreira D.M., Chen Z., Howard L., Berger J.H., Terris M.K., et al. Biopsy detected gleason pattern 5 is associated with recurrence, metastasis and mortality in a cohort of men with high risk prostate cancer. J Urol. 2017;198(6):1309–15. DOI: 10.1016/j. juro.2017.07.009Stroup S.P., Moreira D.M., Chen Z., Howard L., Berger J.H., Terris M.K., et al. Biopsy detected gleason pattern 5 is associated with recurrence, metastasis and mortality in a cohort of men with high risk prostate cancer. J Urol. 2017;198(6):1309–15. DOI: 10.1016/j. juro.2017.07.009Vernooij R.W., Lancee M., Cleves A., Dahm P., Bangma C.H., Aben K.K. Radical prostatectomy versus deferred treatment for localised prostate cancer. Cochrane Database Syst Rev. 2020;6(6):CD006590. DOI: 10.1002/14651858.CD006590.pub3Vernooij R.W., Lancee M., Cleves A., Dahm P., Bangma C.H., Aben K.K. Radical prostatectomy versus deferred treatment for localised prostate cancer. Cochrane Database Syst Rev. 2020;6(6):CD006590. DOI: 10.1002/14651858.CD006590.pub3

The authors declare that there are no conflicts of interest present.