Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base

被引：27

作者：

Chin, Joseph L. ^{[1
]}

Srigley, John ^{[2
]}

Mayhew, Linda A. ^{[3
]}

Rumble, R. Bryan ^{[4
]}

Crossley, Claire ^{[5
]}

Hunter, Amber ^{[6
]}

Fleshner, Neil ^{[7
]}

Bora, Bish ^{[8
]}

McLeod, Robin ^{[9
]}

McNair, Sheila ^{[4
]}

Langer, Bernard

Evans, Andrew ^{[10
]}

机构：

[1] London Hlth Sci Ctr, London, ON N6A 4G5, Canada

[2] Canc Care Ontario, Pathol & Lab Med, Mississauga, ON, Canada

[3] Princess Margaret Hosp, Univ Hlth Network, DRO, Radiat Med Program, Toronto, ON M4X 1K9, Canada

[4] McMaster Univ, Canc Care Ontario Program Evidence Based Care, Hamilton, ON, Canada

[5] Canadian Inst Hlth Informat, Hlth Serv Res, Toronto, ON, Canada

[6] Canc Care Ontario, Surg Oncol Program, Toronto, ON, Canada

[7] Princess Margaret Hosp, Div Urol, Toronto, ON M4X 1K9, Canada

[8] Sudbury Reg Hosp, Sudbury, ON, Canada

[9] Canc Care Ontario, Qual Improvement & Knowledge Transfer, Toronto, ON, Canada

[10] Toronto Gen Hosp, Univ Hlth Network, Toronto, ON, Canada

来源：

CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL | 2010年 / 4卷 / 01期

关键词：

LYMPH-NODE DISSECTION; EXTENDED PELVIC LYMPHADENECTOMY; BIOCHEMICAL FAILURE RATES; BLADDER NECK PRESERVATION; MARGIN STATUS; RETROPUBIC PROSTATECTOMY; POSITIVE MARGINS; DISEASE PROGRESSION; PROGNOSTIC-SIGNIFICANCE; PERINEAL PROSTATECTOMY;

D O I：

10.5489/cuaj.08105

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The objective is to provide surgical and pathological guidelines for radical prostatectomy (RP) with or without concurrent pelvic lymph node dissection (PLND) to achieve optimal benefit for patients, with minimal risk of harm. Methods: For surgical questions, a literature search of MEDLINE, EMBASE and the Cochrane database was performed. A literature search for the pathological questions was not conducted since the protocol for invasive carcinomas of the prostate gland developed by the College of American Pathologists (CAP) was endorsed. Urologists and pathologists were consulted for their assessment of the surgical and pathological recommendations. Results: Limited high-quality evidence from 95 primary studies was available and, therefore, the expert panel developed recommendations on the basis of a consensus of the expert opinion of the working group and through a consultation with urologists and pathologists. In addition to the CAP protocol, some technical recommendations related to the handling and processing of the specimen were made. Conclusion: Radical prostatectomy is recommended for the surgical treatment of prostate cancer, depending on a patient's preoperative risk profile. The panel unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%, rates of rectal injury of <1% and blood transfusion rates of <10% in non-anemic patients. Standard PLND should be mandatory in high-risk patients, should be recommended for intermediate-risk patients and should be optional for low-risk patients. The quality and effectiveness of this treatment and of subsequent patient care depend on good management, effective communication and reporting between surgeons and pathologists working together as part of a multidisciplinary team. The complete guideline document is posted on the Cancer Care Ontario website (www.cancercare.on.ca); search in their Toolbox, Quality Guidelines & Standards, Clinical Program category under "surgery."

引用

页码：13 / 25

页数：13

共 73 条

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