Die roboterassistierte radikale Prostatektomie – Literaturreview zum onkologischen und funktionellen Outcome

Zusammenfassung

Im Jahr 2000 erfolgte in Frankfurt am Main (Deutschland) die weltweit erste roboterassistierte radikale Prostatektomie (RARP) zur operativen Therapie des Prostatakarzinoms (PCA). Es fand seitdem eine schnelle Verbreitung dieser innovativen Operationsmethode statt. In den USA ist die RARP bereits die am häufigsten durchgeführte Therapieform des lokal begrenzten PCA, obwohl die Vorteile dieser minimal-invasiven Prozedur gegenüber anderen Verfahren bislang nicht anhand einer prospektiv-randomisierten Studie untersucht wurden. Vor dem Hintergrund der auch in Deutschland zu verzeichnenden raschen Zunahme der RARP als primäre Therapie des lokalisierten PCA soll der vorliegende Artikel einen kritischen Überblick über bisher in der internationalen Literatur publizierte onkologische und funktionelle Ergebnisse der RARP bieten. Die Arbeit folgt hierbei dem Ziel, die Sicherheit der RARP hinsichtlich der Erlangung der Pentafecta-Outcome Kriterien (kein PSA-Rezidiv, vollständige Erlangung der Harnkontinenz und Erektionsfähigkeit, negativer chirurgischer Schnittrand und keine postoperativen Komplikationen) zu bewerten, jenen Kriterien, die 2011 von Patel et al. erstmalig beschrieben wurden.

Abstract

In 2000, the first robot-assisted radical prostatectomy (RARP) worldwide for treatment of prostate cancer (PCa) was performed in Frankfurt/Main (Germany). Since then, this surgical method has broadly dispersed. In the US, RARP currently already represents the most frequently applied surgical technique for treatment of localized PCa, although until now the potential benefits of RARP in comparison to alternative surgical procedures have still not been evaluated in prospective randomized trials. Against the background that also in Germany a continuously and fast growing number of patients are treated by RARP, the present article provides a comprehensive and critical review of internationally published data concerning oncological and functional results of RARP. The main focus represents evaluation of the safety of this procedure with respect to achieving Pentafecta criteria (i.e. no biochemical recurrence, complete urinary continence and erectile function, negative surgical margins, and no postoperative complications), which were primarily described by Patel et al. in 2011.

Key words

RARP - Pentafecta - Prostatakarzinom - technische Innovationen - operative Lernkurve

Key words

RARP - Pentafecta - prostate cancer - technical innovations - surgical learning curve

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