Kombine Açık Radikal Prostatektomi: Fonksiyonel ve Onkolojik Değerlendirme

Year 2020, Volume: 7 Issue: 2, 70 - 75, 31.08.2020

İlker Akarken , Hüseyin Tarhan , Ömer Erdoğan , Mustafa Kestel , Hasan Deliktaş , Mehmet Çetinkaya Yelda Morgül Dere , Hayrettin Şahin

Abstract

Prostat kanseri erkeklerde en sık tanı konulan kanser türlerinden biridir. Prostat spesifik antijen (PSA) taramasıyla birlikte hastalar daha erken dönemde tanı almakta ve daha fazla sayıda hasta radikal prostatektomi (RP) operasyonu geçirmektedir. RP açık, laparoskopik ve robot yardımlı teknikler ile uygulanabilmektedir. Ayrıca açık RP için retrograd ve antegrad teknikler tarif edilmiştir. Biz kliniğimizde her iki tekniğin karşımı olan kombine tekniği uygulamaktayız. Bu çalışmada kombine açık RP tekniğinin onkolojik ve fonksiyonel sonuçlara etkisi araştırıldı. 2012-2018 yılları arasında kombine RP uygulanan 89 hastanın verileri retrospektif olarak değerlendirildi. Kombine teknikte hastaların tümüne denonviller fasyasına kadar retrograde yöntem uygulanırken, bu aşamadan sonra antegrad yöntem uygulandı. 12 aylık takip sonunda idrar kaçırması olmayan hastalar kontinan kabul edildi. Erektil fonksiyon uluslararası erektil fonksiyon indeksine göre değerlendirildi; bu değer 19’un üzerinde ise hastalar potent kabul edildi. Ortalama operasyon süresi 125.4±15dk, per-op kan kaybı 350±50ml olarak saptandı. Operasyon sonrasında ortalama hastanede yatış süresi 7±2 gün bulundu. Hastalar ortalama 18,5 ay takip edildi. Takip süresince sadece 1 (%1) hasta kardiyak nedenle ex oldu ve 23 (%25) hastada PSA nüksü saptandı. Hastaların takiplerinde 24 (%27) hastada erektil disfonksiyon saptanırken, 26 (%29) hastada üriner inkontinans saptandı. Kombine RP’nin diğer yöntemlerle benzer onkolojik ve fonksiyonel sonuçları olduğu ortaya konulmuştur.

Keywords

Açık Radikal Prostatektomi, Kombine Teknik, Prostat Kanseri

Combined Open Radical Prostatectomy: Functional and Oncologic Assessment

Abstract

Prostate cancer is one of the most common malignancies in males. Since the widespread use of prostate specific antigen (PSA) screening, more patients are diagnosed at early stages of the disease and subsequently underwent radical prostatectomy (RP). RP may be performed via open, laparoscopic or robot assisted laparoscopic techniques. Open RP may be performed in an antegrade or retrograde fashion. In this study, we assessed the oncologic and functional effects of combined retrograde and antegrade open RP technique. The data of 89 patients, who underwent combined RP between 2012 to 2018, were assessed retrospectively. The combined technique is performed retrograde way until to the Denonvilliers' fascia dissection and advanced with antegrade way in the rest of the operation. Urinary continence and erectile functions were assessed after 12 months follow-up. Erectile functions were assessed with International Index of Erectile Function (IIEF). Patients with IIEF scores >19 were considered as potent. Mean operation time, blood loss and hospital stay were 125.4±15min and 350±50ml, 7±2 days, respectively. In mean 18.5 months of follow-up, only 1 (1%) of the patients were died due to a cardiac event and 23 (25%) had PSA recurrence. Erectile disfunction and urinary incontinence were detected in 24 (27%) and 26 (29%) patients, respectively. The combined RP technique has similar oncologic and functional results with other techniques.

Keywords

Combined Technique, Open Radical Prostatectomy, Prostate Cancer

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