- 期刊
Minimally Invasive Surgery for Localized Prostate Cancer
綜合評論—局限性攝護腺癌之微創手術治療
摘要
攝護腺癌在歐美是最常被診斷的惡性腫瘤。雖然在台灣攝護腺癌的發生率不高，但近20年逐漸升高。局線性攝護腺癌之微創手術包括：腹腔鏡及機械手臂根除性攝護腺切除，在本院接受根除性攝護腺切除術之病患，約有70％採用機械手臂切除攝護腺，機械手臂根除性攝護腺切除術有潛力成為治療局限性攝護腺癌的主流方式。腹腔鏡攝護腺切除術之術後12 個月禁尿控制率達66％－95％，12個月及18個月性功能恢復達42％及76％，機械手臂根除性攝護腺切除有較好的禁尿率 84％－97％，性功能恢復達70％－80％手術邊緣腫瘤陽性率在腹腔鏡手術為11％－30％，機械手臂為9.6％－26％，從單一手術醫師擔270例的經驗，顯示良好的禁尿率及可接受的性功能恢復率，對於腫瘤控制降低手術邊緣陽性率，仍有很大的改善空間。
並列摘要
Prostate cancer is the most commonly diagnosed solid tumor cancer in both Europe and the US. Although there were previously low incidence and mortality rates of prostate cancer in Taiwan, these rates have risen rapidly in the past two decades. Options for minimally invasive surgical treatment of localized prostate cancer include laparoscopic radical prostatectomy (LRP), and robotic-assisted laparoscopic radical prostatectomy (RALP). Trends in treatment for localized prostate cancer after emergence of robotic-assisted laparoscopic radical prostatectomy were obvious. The percentage of RALP in patients with localized prostate cancer receiving radical prostatectomy is now about 70% in this institute. There is potential of robotic-assisted prostatectomy to become the mainstream treatment for localized prostate cancer in Taiwan. Twelve-month continence rates ranged from 66% to 95% after LRP. In terms of erectile function recovery, the 12- and 18-mo potency rates reported in noncomparative studies ranged from 42% to 76% after LRP. Better functional results were suggested following RALP. Excellent functional outcomes were reported in several large series from referral centers with high volume of RALP, showing continence rates ranging from 84% to 97% and potency rates from 70% to 80%. The positive surgical margin (PSM) rate was from 11% to 30% after LRP, and from 9.6% to 26% after RALP. Experience with 270 cases of RALP performed by single surgeon showed excellent continence rate and acceptable potency rate. There is still much room to improve cancer control by reducing the positive surgical margin rate.