Introducción:

La prostatectomía radical asistida por robot (PRAR) es cada vez más utilizada alrededor del mundo. En México existen 13 hospitales que cuentan con equipo de cirugía robótica. En otros países ha demostrado disminuir la morbilidad quirúrgica con la misma efectividad en resultados oncológicos y funcionales.

Objetivo:

Reportar los resultados de experiencia inicial y seguimiento a corto plazo de RARP en el Centro Médico Naval.

Material y métodos:

Se realizó una revisión retrospectiva de los pacientes sometidos a PRAR en nuestra unidad del 19 marzo 2016 al 30 abril 2018 que cumplieran con al menos 6 meses de seguimiento postquirúrgico.

Resultados:

Se realizaron 48 PRAR, con una media de edad de 64.7 años, APE preoperatorio medio de 10.4 ng/dl, con clasificación de riesgo bajo, intermedio y alto de 19, 29 y 52%. El tiempo quirúrgico medio fue de 240 minutos, sangrado medio 223 ml, 3 días de estancia hospitalaria. Se neuro preservo al 56.3%, y se realizó linfadenectomía estándar a 68.8 y extendida a 31.2%. Tasa de bordes positivos del 45.8%. Se reportó falla bioquímica en el 14.6%. Un 12.5% recibieron radioterapia externa postquirúrgica. El tiempo medio de seguimiento fue de 9 meses. Documentamos una tasa de continencia completa en 91.3% de los pacientes y función eréctil suficiente para sexo en el 53.5% de los pacientes.

Conclusiones:

Reportamos resultados similares a los de la literatura mundial en morbilidad funcional y perioperatoria, en el inicio de nuestra curva de aprendizaje a pesar de tener una población con características de alto riesgo.

Background:

The performance of robotic-assisted radical prostatectomy (RARP) is increasing worldwide. In Mexico, 13 hospitals are equipped to carry out robotic surgery. In other countries, the procedure has been shown to reduce surgical morbidity, as well as providing the same effectiveness in oncologic and functional results offered by open prostatectomy.

Objective:

To report the results of the initial experience with RARP at the Centro Médico Naval and the short-term patient follow-up.

Material and Methods:

A retrospective review of the patients that underwent RARP at our unit and that had a postoperative follow-up of at least 6 months was conducted. The time frame of the study was from March 19, 2016 to April 30, 2018.

Results:

Forty-eight RARPs were performed. Mean age of the patients was 64.7 years and mean preoperative PSA was 10.4 ng/dl. Nineteen percent of the patients were classified as low-risk, 29% as intermediate-risk, and 52% as high- risk. In mean values, surgery duration was 240 minutes, blood loss was 223 ml, and hospital stay was 3.87 days. Nerve sparing was performed in 56.3% of the patients. Standard lymphadenectomy was carried out in 68.8% of the cases and the extended procedure in 31.2%. The positive surgical margin rate was 45.8%. A total of 14.6% patients had biochemical failure and 12.5% received postoperative external beam radiotherapy. Mean follow-up time was 9 months. We documented a complete continence rate of 91.3% and the quality of erectile function was sufficient for having sexual intercourse in 53.5% of the patients.

Conclusions:

The perioperative and functional morbidity results for the beginning of our learning curve were similar to those reported in the international literature, despite the high-risk characteristics of our population.

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