群馬大学医学部附属病院におけるロボット支援腹腔鏡下前立腺全摘（RALP）術の短期成績
【目 的】 群馬大学医学部附属病院では，2014年6月に群馬県で初めてロボット支援腹腔鏡下前立腺全摘（RALP）を開始し，2018年12月で204例を経験した．短期成績，安全性につき報告する． 【対 象】 2014年6月から2017年12月までのRALP153例． 【成 績】 神経温存108例，リンパ節郭清（LND）81例，全例に間接鼠径ヘルニア予防法を行った．POD6膀胱造影でのリーク率99.3％，POD7退院率94.8％．術中の直腸，尿管，閉鎖神経，大血管損傷．膀胱縫縮必要率13.1％．再入院に小腸穿孔疑い例あり保存的に改善．尿閉，症候性リンパ嚢胞．術後に鼠径ヘルニアを5例（3％）に認め手...
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| Published in | 北関東医学 Vol. 70; no. 2; pp. 83 - 94 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
北関東医学会
01.05.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1343-2826 1881-1191 |
| DOI | 10.2974/kmj.70.83 |
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| Abstract | 【目 的】 群馬大学医学部附属病院では，2014年6月に群馬県で初めてロボット支援腹腔鏡下前立腺全摘（RALP）を開始し，2018年12月で204例を経験した．短期成績，安全性につき報告する． 【対 象】 2014年6月から2017年12月までのRALP153例． 【成 績】 神経温存108例，リンパ節郭清（LND）81例，全例に間接鼠径ヘルニア予防法を行った．POD6膀胱造影でのリーク率99.3％，POD7退院率94.8％．術中の直腸，尿管，閉鎖神経，大血管損傷．膀胱縫縮必要率13.1％．再入院に小腸穿孔疑い例あり保存的に改善．尿閉，症候性リンパ嚢胞．術後に鼠径ヘルニアを5例（3％）に認め手術を行った．切除断端陽性（RM1）率pT2；25/135（18.5％），pT3；10/17（58.8％）も，2017年ではpT2；2/39例（5.1％）と改善し，直近ではpT3症例でも減少しつつあった．神経温存側でのRM1は2/108例（1.9％）．摘出リンパ節数の中央値は16個で，転移を3例に認めた．PSA非再発率は12か月89.9％，24か月83.6％で，RM，GG（2以下vs3以上），生検時PSA値で有意差を認めた．術後の尿禁制は，1,3,6,9,12,24ヶ月で，パット使用；9.4％，31％，57％，69％，70％，81％，パット1枚/日まで使用；56％，86％，93％，95％，95％，93％で，神経温存群，摘出前立腺重量の少ない群，70歳未満で早期にパットとなる割合が有意に高かった． 【結 論】 当院では，RALPを安全に導入し，標準的な短期成績を得られたものと思われた．また，被膜外浸潤など広範囲切除が必要な例の結果改善のため，術者育成のためなど，今後も安全に経験を積み重ねていく必要があると思われる． |
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| AbstractList | 【目 的】 群馬大学医学部附属病院では，2014年6月に群馬県で初めてロボット支援腹腔鏡下前立腺全摘（RALP）を開始し，2018年12月で204例を経験した．短期成績，安全性につき報告する． 【対 象】 2014年6月から2017年12月までのRALP153例． 【成 績】 神経温存108例，リンパ節郭清（LND）81例，全例に間接鼠径ヘルニア予防法を行った．POD6膀胱造影でのリーク率99.3％，POD7退院率94.8％．術中の直腸，尿管，閉鎖神経，大血管損傷．膀胱縫縮必要率13.1％．再入院に小腸穿孔疑い例あり保存的に改善．尿閉，症候性リンパ嚢胞．術後に鼠径ヘルニアを5例（3％）に認め手術を行った．切除断端陽性（RM1）率pT2；25/135（18.5％），pT3；10/17（58.8％）も，2017年ではpT2；2/39例（5.1％）と改善し，直近ではpT3症例でも減少しつつあった．神経温存側でのRM1は2/108例（1.9％）．摘出リンパ節数の中央値は16個で，転移を3例に認めた．PSA非再発率は12か月89.9％，24か月83.6％で，RM，GG（2以下vs3以上），生検時PSA値で有意差を認めた．術後の尿禁制は，1,3,6,9,12,24ヶ月で，パット使用；9.4％，31％，57％，69％，70％，81％，パット1枚/日まで使用；56％，86％，93％，95％，95％，93％で，神経温存群，摘出前立腺重量の少ない群，70歳未満で早期にパットとなる割合が有意に高かった． 【結 論】 当院では，RALPを安全に導入し，標準的な短期成績を得られたものと思われた．また，被膜外浸潤など広範囲切除が必要な例の結果改善のため，術者育成のためなど，今後も安全に経験を積み重ねていく必要があると思われる． |
| Author | 宮尾, 武士 宮澤, 慶行 栗原, 聡太 中山, 紘史 鈴木, 和浩 桶川, 隆嗣 周東, 孝浩 松井, 博 関根, 芳岳 岡内, 研三 小池, 秀和 柴田, 康博 服部, 一紀 野村, 昌史 |
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| Copyright | 2020, 北関東医学会 |
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| References | 11. 神波大己．手術時間・出血量・合併症．臨床泌尿器科 2015; 69: 840-846. 15. Okubo H, Ohori M, Ohno Y, et al. Prediction of non-biochemical recurrence rate after radical prostatectomy in a Japanese cohort: Development of a postoperative nomogram. Int J Urol 2014; 21: 479-483. 19. Abdollah F, Gandaglia G, Suardi N, et al. More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol 2015; 67: 212-219. 26. Ma X, Tang K, Yang C, et al. Bladder neck preservation improves time to continence after radical prostatectomy: A systematic review and meta-analysis. Oncotarget 2016; 7: 67463-67475. 29. Joshi AR, Spivak J, Rubach E, et al. Concurrent robotic trans-abdominal pre-peritoneal (TAP) herniorrhaphy during robotic-assisted radical prostatectomy. Int J Med Robot 2010; 6: 311-314. 1. 前立腺癌診療ガイドライン 2016年版 編集 日本泌尿器科学会 大阪：メディカルレビュー社，2016 10. 小林将行，滑川剛史，今村有佑ら．前立腺癌におけるロボット支援腹腔鏡下前立腺全摘除術：単一施設における初期120例の経験．Jpn J Endourol 2013; 26: 238-245. 12. Novara G, Ficarra V, Mocellin S, et al. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 2012; 62: 382-404. 25. Steineck G, Bjartell A, Hugosson J, et al. Degree of preservation of the neurovascular bundles during radical prostatectomy and urinary continence 1 year after surgery. Eur Urol 2015; 67: 559-568. 7. Pierorazio PM, Walsh PC, Partin AW, et al. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 2013; 111: 753-760. 28. Koike H, Matsui H, Morikawa Y, et al. Simple method for preventing inguinal hernias after radical retropubic prostatectomy. Prostate Int 2013; 1: 76-80. 14. 水野桂，井上貴博，宮崎有ら．京都大学病院での前立腺全摘術における神経温存適応基準構築に関する検討．泌尿器科紀要 2014; 60: 543-547. 21. Gandaglia G, Fossati N, Zaffuto E, et al. Development and internal validation of a novel model to identify the candidates for extended pelvic lymph node dissection in prostate cancer. Eur Urol 2017; 72: 632-640. 20. Seiler R, Studer UE, Tschan K, et al. Removal of limited nodal disease in patients undergoing radical prostatectomy: Long-term results confirm a chance for cure. J Urol 2014; 191: 1280-1285. 3. Montorsi F, Wilson TG, Rosen RC, et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 2012; 62: 368-381. 4. Reeves F, Preece P, Kapoor J, et al. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: Results of a systematic review and meta-analysis. Eur Urol 2015; 68: 692-704. 8. Novara G, Ficarra V, Rosen RC, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012; 62: 431-452. 13. Tatsugami K, Yoshioka K, Shiroki R, et al. Reality of nerve sparing and surgical margins in surgeons' early experience with robot-assisted radical prostatectomy in Japan. Int J Urol 2017; 24: 191-196. 5. Beck S, Skarecky D, Osann K, et al. Transverse versus vertical camera port incision in robotic radical prostatectomy: Effect on incisional hernias and cosmesis. Urology 2011; 78: 586-590. 2. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int 2001; 87: 408-410. 6. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452-458. 17. Hashimoto T, Yoshioka K, Nagao G, et al. Prediction of biochemical recurrence after robot-assisted radical prostatectomy: analysis of 784 Japanese patients. Int J Urol 2015; 22: 188-193. 16. Hashimoto T, Yoshioka K, Gondo T, et al. Preoperative prognostic factors for biochemical recurrence after robot-assisted radical prostatectomy in Japan. Int J Clin Oncol 2014; 19: 702-707. 23. Grande P, Di Pierro GB, Mordasini L, et al. Prospective randomized trial comparing titanium clips to bipolar coagulation in sealing lymphatic vessels during pelvic lymph node dissection at the time of robot-assisted radical prostatectomy. Eur Urol 2017; 71: 155-158. 22. Morizane S, Honda M, Fukasawa S, et al. Comparison of the diagnostic efficacy and perioperative outcomes of limited versus extended pelvic lymphadenectomy during robot‑assisted radical prostatectomy: a multi‑institutional retrospective study in Japan. Int J Clin Oncol 2018; 23: 568-575. 27. Stranne J, Johansson E, Nilsson A, et al. Inguinal hernia after radical prostatectomy for prostate cancer: Results from a randomized setting and a nonrandomized setting. Eur Urol 2010; 58: 719-726. 24. Reeves F, Preece P, Kapoor J, et al. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates:results of a systematic review and meta-analysis. Eur Urol 2015; 68: 692-704. 9. 吉村耕治．特有の合併症とその予防．臨床泌尿器科 2013; 67: 333-338. 18. Schiavina R, Manferrari F, Garofalo M, et al. The extent of pelvic lymph node dissection correlates with the biochemical recurrence rate in patients with intermediate- and high-risk prostate cancer. BJU Int 2011; 108: 1262-1268. 30. Ludwig WW, Sopko NA, Azoury SC, et al. Inguinal hernia repair during extraperitoneal robot-assisted laparoscopic radical prostatectomy. J Endourol 2016; 30: 208-211. |
| References_xml | – reference: 7. Pierorazio PM, Walsh PC, Partin AW, et al. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 2013; 111: 753-760. – reference: 11. 神波大己．手術時間・出血量・合併症．臨床泌尿器科 2015; 69: 840-846. – reference: 23. Grande P, Di Pierro GB, Mordasini L, et al. Prospective randomized trial comparing titanium clips to bipolar coagulation in sealing lymphatic vessels during pelvic lymph node dissection at the time of robot-assisted radical prostatectomy. Eur Urol 2017; 71: 155-158. – reference: 2. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int 2001; 87: 408-410. – reference: 16. Hashimoto T, Yoshioka K, Gondo T, et al. Preoperative prognostic factors for biochemical recurrence after robot-assisted radical prostatectomy in Japan. Int J Clin Oncol 2014; 19: 702-707. – reference: 20. Seiler R, Studer UE, Tschan K, et al. Removal of limited nodal disease in patients undergoing radical prostatectomy: Long-term results confirm a chance for cure. J Urol 2014; 191: 1280-1285. – reference: 1. 前立腺癌診療ガイドライン 2016年版 編集 日本泌尿器科学会 大阪：メディカルレビュー社，2016． – reference: 22. Morizane S, Honda M, Fukasawa S, et al. Comparison of the diagnostic efficacy and perioperative outcomes of limited versus extended pelvic lymphadenectomy during robot‑assisted radical prostatectomy: a multi‑institutional retrospective study in Japan. Int J Clin Oncol 2018; 23: 568-575. – reference: 21. Gandaglia G, Fossati N, Zaffuto E, et al. Development and internal validation of a novel model to identify the candidates for extended pelvic lymph node dissection in prostate cancer. Eur Urol 2017; 72: 632-640. – reference: 25. Steineck G, Bjartell A, Hugosson J, et al. Degree of preservation of the neurovascular bundles during radical prostatectomy and urinary continence 1 year after surgery. Eur Urol 2015; 67: 559-568. – reference: 13. Tatsugami K, Yoshioka K, Shiroki R, et al. Reality of nerve sparing and surgical margins in surgeons' early experience with robot-assisted radical prostatectomy in Japan. Int J Urol 2017; 24: 191-196. – reference: 27. Stranne J, Johansson E, Nilsson A, et al. Inguinal hernia after radical prostatectomy for prostate cancer: Results from a randomized setting and a nonrandomized setting. Eur Urol 2010; 58: 719-726. – reference: 30. Ludwig WW, Sopko NA, Azoury SC, et al. Inguinal hernia repair during extraperitoneal robot-assisted laparoscopic radical prostatectomy. J Endourol 2016; 30: 208-211. – reference: 17. Hashimoto T, Yoshioka K, Nagao G, et al. Prediction of biochemical recurrence after robot-assisted radical prostatectomy: analysis of 784 Japanese patients. Int J Urol 2015; 22: 188-193. – reference: 4. Reeves F, Preece P, Kapoor J, et al. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: Results of a systematic review and meta-analysis. Eur Urol 2015; 68: 692-704. – reference: 19. Abdollah F, Gandaglia G, Suardi N, et al. More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol 2015; 67: 212-219. – reference: 28. Koike H, Matsui H, Morikawa Y, et al. Simple method for preventing inguinal hernias after radical retropubic prostatectomy. Prostate Int 2013; 1: 76-80. – reference: 5. Beck S, Skarecky D, Osann K, et al. Transverse versus vertical camera port incision in robotic radical prostatectomy: Effect on incisional hernias and cosmesis. Urology 2011; 78: 586-590. – reference: 15. Okubo H, Ohori M, Ohno Y, et al. Prediction of non-biochemical recurrence rate after radical prostatectomy in a Japanese cohort: Development of a postoperative nomogram. Int J Urol 2014; 21: 479-483. – reference: 8. Novara G, Ficarra V, Rosen RC, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012; 62: 431-452. – reference: 26. Ma X, Tang K, Yang C, et al. Bladder neck preservation improves time to continence after radical prostatectomy: A systematic review and meta-analysis. Oncotarget 2016; 7: 67463-67475. – reference: 3. Montorsi F, Wilson TG, Rosen RC, et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 2012; 62: 368-381. – reference: 18. Schiavina R, Manferrari F, Garofalo M, et al. The extent of pelvic lymph node dissection correlates with the biochemical recurrence rate in patients with intermediate- and high-risk prostate cancer. BJU Int 2011; 108: 1262-1268. – reference: 6. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452-458. – reference: 14. 水野桂，井上貴博，宮崎有ら．京都大学病院での前立腺全摘術における神経温存適応基準構築に関する検討．泌尿器科紀要 2014; 60: 543-547. – reference: 24. Reeves F, Preece P, Kapoor J, et al. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates:results of a systematic review and meta-analysis. Eur Urol 2015; 68: 692-704. – reference: 29. Joshi AR, Spivak J, Rubach E, et al. Concurrent robotic trans-abdominal pre-peritoneal (TAP) herniorrhaphy during robotic-assisted radical prostatectomy. Int J Med Robot 2010; 6: 311-314. – reference: 9. 吉村耕治．特有の合併症とその予防．臨床泌尿器科 2013; 67: 333-338. – reference: 10. 小林将行，滑川剛史，今村有佑ら．前立腺癌におけるロボット支援腹腔鏡下前立腺全摘除術：単一施設における初期120例の経験．Jpn J Endourol 2013; 26: 238-245. – reference: 12. Novara G, Ficarra V, Mocellin S, et al. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 2012; 62: 382-404. |
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| Title | 群馬大学医学部附属病院におけるロボット支援腹腔鏡下前立腺全摘（RALP）術の短期成績 |
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| ispartofPNX | 北関東医学, 2020/05/01, Vol.70(2), pp.83-94 |
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