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Robotisch assistierte radikale Prostatektomie

Robotic-assisted radical prostatectomy

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Zusammenfassung

Hintergrund

Die robotisch assistierte laparoskopische radikale Prostatektomie (RALP) hat sich innerhalb kurzer Zeit als Standardeingriff zur Behandlung des organbegrenzten Prostatakarzinoms (PCA) etabliert. Trotz des erhöhten Kostenfaktors werden v. a. Vorteile gegenüber der offenen radikalen Prostatektomie (ORP) in Bezug auf Blutungsrisiko sowie der funktionellen und onkologischen Ergebnisse gesehen. Große prospektiv randomisierte Studien hierzu fehlen allerdings bis heute.

Ziel

In dieser Übersichtsarbeit wird über die aktuelle Datenlage zur RALP berichtet. Zudem wird insbesondere auf Vergleiche zur ORP bezüglich Ergebnis und Komplikation eingegangen. Insbesondere wird der Stellenwert der RALP bei organüberschreitenden/aggressiven PCA thematisiert.

Ergebnisse

Nach Durchsicht der aktuellen Literatur bietet die RALP gegenüber der ORP Vorteile in Bezug auf Kontinenz und Potenz. Auch die Rate an positiven Absetzungsrändern scheint, zumindest bei organbegrenzten PCA, geringer zu sein. Allerdings ist die Datenlage bei organüberschreitenden Tumoren kontrovers. Bezüglich der onkologischen Langzeitergebnisse scheint die RALP mit der ORP vergleichbar zu sein.

Abstract

Background

Robot-assisted laparoscopic radical prostatectomy (RALP) has been rapidly adopted as a standard approach for surgical treatment of organ-confined prostate cancer. Despite additional costs, RALP seems to provide better functional and oncological outcomes and less blood loss compared to open radical prostatectomy (ORP). However, prospective randomized studies are still missing.

Purpose

Based on the current literature, this review reports about the role of RALP in prostate cancer treatment. Its functional and oncologic outcomes as well as complication rates are compared to ORP. Particularly, the role of RALP in nonorgan-confined tumors will be discussed.

Results

Based on the current literature, RALP provides better continence and potency rates as compared to ORP. Moreover, the incidence of positive surgical margins seems to be reduced. However, there is conflicting data regarding the role of RALP in nonorgan-confined prostate cancer. Regarding long-term oncologic outcomes, RALP seems to be comparable to ORP.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Thomas, A. Neisius, F.C. Roos, C. Hampel und J.W. Thüroff geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    C. Thomas, A. Neisius, F.C. Roos, C. Hampel & J.W. Thüroff

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  1. C. Thomas
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  2. A. Neisius
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  3. F.C. Roos
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  4. C. Hampel
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  5. J.W. Thüroff
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Correspondence to C. Thomas.

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Thomas, C., Neisius, A., Roos, F. et al. Robotisch assistierte radikale Prostatektomie. Urologe 54, 178–182 (2015). https://doi.org/10.1007/s00120-014-3665-3

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  • DOI: https://doi.org/10.1007/s00120-014-3665-3

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