Clinical analysis of neoadjuvant hormonal therapy with laparoscopic radical prostatectomy in high-risk and local advanced prostate cancer
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摘要: 目的：探讨新辅助内分泌治疗联合腹腔镜前列腺癌根治术治疗高危及局部晚期前列腺癌的可行性及临床效果。方法：回顾性分析2015年1月~2017年1月临沂市中心医院确诊的36例高危及局部晚期前列腺癌患者临床资料，先行3个月辅助内分泌治疗，再行腹腔镜前列腺癌根治术，术后即刻给予辅助内分泌治疗。结果：手术均获得成功，无中转开放手术。平均手术时间为（201±21） min，平均出血量为（240±122） ml，平均住院时间为（20.6±2.3） d，平均术后留置尿管和引流管时间分别为（14.8±3.8） d和（5.6±2.8） d，切缘阳性5例（13.9%），淋巴结阳性11例（30.6%），术后尿失禁2例，尿瘘1例，勃起功能障碍22例。术后随访12~36个月，平均24个月，术后1年尿控满意率为91.6%（33/36），术后1、2年生化复发率分别为25.0%（9/36）和38.9%（14/36）。结论：新辅助内分泌治疗联合腹腔镜下前列腺癌根治术治疗高危及局部晚期前列腺癌安全、可行，但有较高的淋巴结阳性率和生化复发率，术后需要进一步治疗及随访观察。
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关键词:
- 前列腺肿瘤 /
- 腹腔镜前列腺癌根治术 /
- 新辅助内分泌治疗 /
- 高危 /
- 局部晚期
Abstract: Objective: To investigate the clinical effect of neoadjuvant hormonal therapy with laparoscopic radical prostatectomy on high-risk and local advanced prostate cancer. Method: From January 2015 to January 2017, the clinical data of 36 patients of high-risk and local advanced prostate cancer were retrospectively analyzed. They received three-month neoadjuvant endocrine therapy(maximal androgen blockade) and laparoscopic radical prostatectomy in sequence. Result: All operations were successfully performed without conversion to open surgery. The mean operation time was(201±21) min, mean blood loss was(240±122) ml, average hospital stay was(20.6±2.3) d, mean indwelling catheter time and drainage tube time were(14.8±3.8) d and(5.6±2.8) d respectively. Positive surgical margin and positive lymph node were found in 5 and 11 patients respectively. The complications included incontinence in 2 cases, anastomotic leakage in 1 case and erectile dysfunction in 22 cases. With the median of 24 months follow-up(range 12-36 months), the urinary continence rate one year after operation was 91.6%(33/36), and biochemical recurrence in 1-year and 2-year after surgery were 25%(9/36) and 38.9%(14/36) respectively.Conclusion: Neoadjuvant endocrine therapy in combination with laparoscopic radical prostatectomy is safe and feasible for patients with high risk and local advanced prostate cancer. However, relative high rates of positive lymph node and biochemical recurrence still exist. Further treatment and follow-up observation may be considered. -
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