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Laparoskopische radikale Prostatektomie

Laparascopic radical prostatectomy

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Zusammenfassung

Hintergrund

Die laparoskopische radikale Prostatektomie (LRP) hat sich seit der Erstbeschreibung vor über 20 Jahren als Standardverfahren zur Therapie des lokal begrenzten Prostatakarzinoms etabliert. Aktuell wird die LRP trotz der hohen Zusatzkosten zunehmend durch die roboterassistierte Methode (RALP) verdrängt.

Fragestellung

Was sagen ausgewählte Fallserien mit einem Follow-up von ca. 10 Jahren über die onkologische Effektivität nach mittlerer Nachbeobachtungszeit aus? Gibt es Unterschiede zwischen LRP und RALP im onkologischen oder funktionellen Outcome?

Material und Methoden

Es werden aktuelle Arbeiten der LRP mit einem medianen onkologischen Follow-up von mindestens 3 Jahren und Vergleichsstudien von LRP und RALP berücksichtigt.

Ergebnisse

Es liegen erste überzeugende Ergebnisse von Fallserien zum onkologischen 10-Jahres-Follow-up nach LRP vor. Neuere Daten deuten darauf hin, dass die RALP der LRP hinsichtlich funktioneller Ergebnisse (Wiedererlangen der erektilen Funktion) nach beidseitigem Nerverhalt überlegen ist.

Schlussfolgerung

Nachdem erste Reviews vor einigen Jahren vergleichbare onkologische und funktionelle Ergebnisse von offener Prostatektomie, LRP und RALP zeigten, deuten neuere vergleichende Studien auf unterschiedliche funktionelle Ergebnisse zugunsten der RALP nach beidseitigem Nerverhalt hin. Dieser Vorteil ist nach „wide excision“ der neurovaskulären Bündel nicht erwiesen. Beide Verfahren sind zur Therapie des lokal begrenzten Prostatakarzinoms zu empfehlen.

Abstract

Background

Since its initial description 20 years ago, laparoscopic radical prostatectomy (LRP) is now a standard treatment option for localized prostate cancer. However, in recent years robot-assisted laparoscopic radical prostatectomy (RALP) has been gradually replacing LRP, despite high costs incurred with RALP.

Objectives

The purpose of this work was to determine the oncological outcomes of LRP from selected series with a follow-up of around 10 years and to compare oncological and functional outcomes between LRP and RALP.

Material and methods

The outcomes of a case series of LRP with a median follow-up of at least 3 years were reviewed. In addition, the outcomes of comparative studies between LRP and RALP were reviewed.

Results

The first case series of LRP with follow-ups of 10 years after LRP are available and show favorable oncologic outcomes. Current data show that RALP offers superior functional results (recovery of erectile function) following bilateral nerve sparing when compared to LRP.

Conclusion

The first review a few years ago showed comparable oncologic and functional outcomes between open prostatectomy, LRP, and RALP. Recent data from comparative studies show superiority of RALP over LRP for potency following bilateral nerve sparing. The potency outcomes between LRP and RALP are, however, similar following wide excision of both neurovascular bundles. Therefore, both treatment options can be recommended for the treatment of localized PC.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Ganzer, M. Do, B.P. Rai, A. Dietel und J.-U. Stolzenburg geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to PD Dr. R. Ganzer FEBU.

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Ganzer, R., Do, M., Rai, B. et al. Laparoskopische radikale Prostatektomie. Urologe 54, 172–177 (2015). https://doi.org/10.1007/s00120-014-3664-4

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Schlüsselwörter

  • DaVinci®-System
  • Prostatakarzinom
  • Tumorstadien, pathologische
  • Dysfunktion, erektile
  • Neurovaskuläre Bündel

Keywords

  • DaVinci® system
  • Prostate neoplasms
  • Tumor stage, pathologic
  • Erectile dysfunction
  • Neoplasm metastasis