복강경하 근치적 전립선적출술의 학습 곡선 분석: 후치골 근치적 전립선적출술과의 비교
The Learning Curve Analysis of Laparoscopic Radical Prostatectomy: Comparison with Retropubic Radical Prostatectomy
강민용, 곽철, 김현회, 구자현,
소속 상세정보
강민용 ( Kang Min-Yong )
서울대학교 의과대학 비뇨기과학교실
곽철 ( Kwak Cheol )
서울대학교 의과대학 비뇨기과학교실
김현회 ( Kim Hyeon-Hoe )
서울대학교 의과대학 비뇨기과학교실
구자현 ( Ku Ja-Hyeon )
서울대학교 의과대학 비뇨기과학교실
KMID : 0358320080490010018
Abstract
Purpose: We wanted to compare the early outcome of laparoscopic radical prostatectomy(LRP) as performed by a laparoscopic surgeon without experience with retropubic prostatectomy(RRP), and open RRP as performed by an oncologic surgeon without experience with LRP.
Materials and Methods: We reviewed the clinical data on the initial 31 LRPs(group 1) and the 107 RRPs(group 2), as performed by two surgeons at our institution. The two different surgeons performed each type of operation, respectively. Although each surgeon was an expert of laparoscopic surgery and open surgery respectively, they were unfamiliar with radical prostatectomy.
Results: The mean operation time was longer in group 1 than in group 2(303 minutes vs. 207 minutes, respectively, p＜0.001). However, the estimated mean blood loss(685ml vs. 1,488.0ml, respectively, p＜0.05) and the transfusion rate(24.1% vs. 55%, respectively, p＜0.05) were significantly less in group 1. The mean duration of the hospital stay, the days to oral feeding, the duration of analgesics use and the duration of an indwelling drain were similar between the two groups. The complication rate also did not differ significantly between the two groups(27.6% vs. 23.6%, respectively, p＞0.05), and no conversions or re-explorations were required and rectal injury did not occur in group 1. The histopathologic parameters of the two groups were comparable, especially in terms of the surgical margin positivity(37.9% vs. 43.4%, respectively, p>0.05). The continence rate and potency rate were also comparable between the two groups.
Conclusions: Our findings suggest that early outcome of LRP is comparable to that of RRP. Especially the estimated blood loss and the rate of transfusions were lower in the LRP group. We believe that the surgical outcome of LRP will continue to improve at specialized centers as laparoscopic urologists gain experience, and even though an expert laparoscopic urologist may be a naive for prostate cancer surgery, the learning curve is overcome earlier than expected.
키워드
Laparoscopy;Prostatectomy;Learning curve;Outcome measures
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