A Clinical Comparative Study Of Tumor Control And Functional Protection In The Treatment Of Low And Medium Risk Localized Prostatecancer By Robot-assisted And Laparoscopy

Objective:In order to provide necessary information for the choice of operation mode in the medical center of RARP,we compared the postoperative tumor control effect,urinary continence and sexual function recovery effect of robot-assisted laparoscopic radical prostatectomy and laparoscopic radical prostatectomy in the treatment of localized prostate cancer of low and medium risk.Design,Setting and participants:From March 2016 to April 2019,the clinical and follow-up data of patients undergoing radical prostatectomy in urology department of the First Affiliated Hospital of Nanchang University were collected.In this study,86 patients with localized prostate cancer of low and medium risk,preoperative sexual activity and life expectancy ? 10 years were included,including 46 patients with robot-assisted laparoscopic radical prostatectomy and 40 patients with laparoscopic radical prostatectomy.The changes of post-operative PSA level,positive rate of incision margin,biochemical recurrence rate,IIEF-5 score and urinary continence rate were compared between the two groups.All the evaluation of patients' postoperative conditions were carried out in the follow-up of 6 weeks,3 months,6 months,12 months and 24 months.The statistical software spss22.0 was used to analyze the data,t test was used to measurement data,chi square test was used to enumeration data,Kaplan Meier chart was used to describe and analyze the cumulative survival function,log-rank test was used to find the possible differences among groups after the risk factors of prostate cancer were stratified,and all data analysis with P < 0.05 as the difference was statistically significant.Results:86 patients were included in this study,46 in RARP group and 40 in LRP group.Compared with LRP,there were significant differences in operation time(208.72 ±33.63 vs 227.63 ± 49.75,P = 0.046),intraoperative blood loss(132.24 ± 46.83 vs167.75 ± 63.22,P = 0.004),postoperative hospitalized days(9.28 ± 2.87 vs 12.54± 5.48,P = 0.001).There were significant differences in urinary continence rate between RARP group and LRP group in the immediate(78.3%vs57.5%),3 months(84.8%vs65.0%)and 6 months(91.3%vs75.0%)after operation(P <0.05).Compared with LRP group,the IIEF-5 score of RARP group was significantly higher at 12months(14.54 ± 6.09 vs 10.85 ± 6.64,P = 0.009)and 24 months(17.50 ± 5.35 vs 14.20 ± 6.37,P = 0.011).However,when comparing the success rate of sexual intercourse and the incidence of ED,we found no statistical significant difference(p>0.05).No difference in IIEF-5 score 6 months after surgery was detected(p=0.144).There was no significant difference in urinary continence rate at 12 months after operation,post-operative PSA level,PSM incidence and BCR incidence within 24 months between the two groups(p>0.05).Conclusions:RARP has shorter operative time,less intraoperative blood loss and shorter postoperative hospitalized days and higher urinary continence rate within 6 months after operation than LRP in the treatment of localized prostate cancer of low and medium risk.Meanwhile,RARP can significantly improve the IIEF-5 score in the 12 th and 24 th month after treatment of localized prostate cancer of low and medium risk,but it has no significant effect on the success rate of sexual intercourse and the incidence of ED.Consequently,the clinical value of the benefit still need further assessment.The effect of RARP on tumor control and urinary continence rate in 12 months after operation is similar to that of LRP.