根治的前立腺全摘除術における3手術（ミニマム創小切開，腹腔鏡，ロボット支援手術）の導入期での術式別の比較

Comparison among endoscopic radical prostatectomy during the learning period

◆要旨：限局性前立腺癌に対する内視鏡下手術として，ミニマム創小切開前立腺全摘除術（MIES），腹腔鏡下前立腺全摘除術（LRP），ロボット支援下根治的前立腺全摘除術（RARP）が本邦で行われているが，各々に長短所がある．本研究では導入期の各々単一術者による周術期の結果について術式別に比較した．対象は限局性前立腺癌で手術を施行した32例（MIES 10例，LRP 11例，RARP 11例）で，D'Amicoによるリスク分類のlow : intermediate : highはMIESで2 : 4 : 4, LRPで3 : 8 : 0, RARPで1 : 8 : 2であった．平均手術時間はMIES 214分，LRP 355分，RARP 321分とMIESで有意に短く，平均出血量は各々1,516ml, 1,327ml, 247mlとRARPで少なかった．pT2における断端陽性率はMIES 2/6 （33.3％），LRP 2/7 （28.5％），RARP 1/9 （11.1％）であった．RARPは導入期でも出血量が少なく，根治的切除が期待される．

Minimum incision endoscopic surgery （MIES）, laparoscopic radical prostatectomy （LRP）, and robot-assisted radical prostatectomy （RARP） performed for the treatments of localized prostate cancer are covered by national insurance in Japan. We compared the outcome of the three surgeries during the learning period. A total of thirty-two patients with localized prostate cancer were enrolled in this study. The distribution of patients who underwent radical prostatectomy using the three procedures was as follows: MIES 10 patients, LRP 11 patients, and RARP 11 patients. Furthermore, patients in each group were divided into low-, intermediate-, and high-risk patients according to the D'Amico criteria as follows: 2, 4, and 4 patients in MIES group; 3, 8, and 0 patients in LRP group; 1, 8, and 2 patients in RARP group. The average operating time was 214 minutes for MIES, 355 minutes for LRP, and 321 minutes for RARP. The average operating time for MIES was significantly shorter than that for the other surgeries. The average blood loss （ml） was 1,516, 1,327, and 247 for MIES, LRP, and RARP, respectively. The average blood loss in RARP was significantly lower than that in the other two surgeries. In addition, positive surgical margin rate in pT2 stage was 2/6 （33.3％） for MIES, 2/7 （28.5％） for LRP, and 1/9 （11.1） for RARP. Therefore, RARP was found to be more favorable technique, achieving decreased blood loss and good results for radical surgical treatment even during the learning period.