秋田大学における腹腔鏡下前立腺全摘除術15例の早期成績

Abstract

腹腔鏡下前立腺全摘除術(LapRP)を施行した限局性前立腺癌15例を対象に, 早期成績を恥骨後式前立腺全摘除術(RRP)と比較検討した.LapRPに対して行った開放手術への移行は1例のみで, 大きな合併症はなかった.開放手術のRRPに比べて, 有意に手術時間は長かったが, 出血量は少なく, 術後の摂食や歩行開始時期も早く, カテーテルを早期に抜去できた.尿禁制は全例で保たれ, organ confinedな癌であれば, 根治性にある手術に成り得ることが示唆され, 限局性前立腺癌に対する治療の選択肢の1値に成り得る術式と考えられた

We herein report our experience and early results of laparoscopic radical prostatectomy in 15 cases of localized prostate cancer (11 T1c and 4 T2a tumors) performed between March 2000 and October 2001. The operative procedure was almost identical to the Montsouris technique. Conversion to the open procedure was required only in the first case because of a widely opened bladder neck that involved the ureteral orifice. No severe intraoperative or postoperative complications were observed. The mean operating time and blood loss was 383 minutes and 640 ml including intraoperative urine, respectively. Only one patient required blood transfusion. All 14 patients with a successful procedure could take fluid and walk freely on postoperative day 1. Twelve (86%) of the 14 patients could take food on postoperative day 1 and a Foley catheter was successfully removed on day 6 to 8 in 12 (86%) cases. Histologically, positive surgical margin was observed in 5 (33%) cases and all of them were considered non-organ confined (pT3 or more). Without adjuvant hormonal therapy, biochemical (PSA) failure was observed in 5 (36%) cases (median follow-up period: 11 months). Continence has been well maintained in 12 patients with no need for a pad by 3 months postoperatively and 2 patients are using only 1 pad/day for caution's sake. In terms of early postoperative recovery, intraoperative blood loss and maintenance of continence, laparoscopic radical prostatectomy may give a satisfactory result. Although long-term follow-up is required to assess disease control and maintenance of sexual function, laparoscopic radical prostatectomy may become an alternative for the treatment of organ-confined prostate cancer.