Evaluación de la pentafecta en pacientes con cáncer de próstata de alto y muy alto riesgo: comparación entre prostatectomía radical laparoscópica y prostatectomía abierta
DOI:
https://doi.org/10.48193/rjz6ss85Palabras clave:
Cáncer de próstata, alto riesgo, pentafecta, prostatectomía abierta, prostatectomía laparoscópicaResumen
Introducción: el cáncer de próstata (CaP) es el tumor más frecuente en hombres a nivel mundial. Alrededor del 15% de los casos se presenta como de alto o muy alto riesgo, donde el abordaje quirúrgico óptimo continúa siendo motivo de controversia. La pentafecta se emplea como un indicador clave de éxito quirúrgico, al integrar resultados oncológicos y funcionales. El objetivo fue comparar los resultados de la pentafecta a doce meses entre la prostatectomía radical abierta (PRA) y laparoscópica (PRL) en pacientes con CaP de alto y muy alto riesgo.
Material y métodos: este es un estudio observacional, retrospectivo, realizado entre 2021 y 2024, que incluyó a 25 pacientes con diagnóstico de CaP localizado de alto o muy alto riesgo, sometidos a PRA o PRL con linfadenectomía pélvica extendida. Se analizaron variables clínicas, patológicas y funcionales. Las comparaciones se realizaron mediante Chi-cuadrada, t de Student o U de Mann-Whitney, según la distribución. Se consideró significativa una p<0.05.
Resultados: de los 25 pacientes, doce fueron intervenidos con PRA y trece con PRL. La tasa global de pentafecta fue 36 %. La PRA fue la técnica más frecuente (50 %) frente a PRL (23 %) (p=0.061). La PRA se asoció con mejor control bioquímico (p=0.023), menor tasa de complicaciones (p=0.054) y mejor función eréctil (p=0.005). La continencia fue similar (p=0.317).
Conclusiones: la evaluación con pentafecta global no mostró diferencias estadísticamente significativas; sin embargo, la PRA mostró ventajas clínicas relevantes frente a la PRL.
Referencias
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians. 2021;71(3): 209–249. https://doi.org/10.3322/caac.21660.
Instituto Mexicano del Seguro Social. Protocolo de Atención Integral .Cáncer de Próstata. 2023.
Miyahira AK, Zarif JC, Coombs CC, Flavell RR, Russo JW, Zaidi S, et al. Prostate cancer research in the 21st century; report from the 2021 Coffey-Holden prostate cancer academy meeting. The Prostate. 2022;82(2): 169–181. https://doi.org/10.1002/pros.24262.
National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Prostate Cancer. 2025.
Goldberg H, Baniel J, Yossepowitch O. Defining high-risk prostate cancer. Current Opinion in Urology. 2013;23(4): 337–341. https://doi.org/10.1097/MOU.0b013e328361dba6.
Hussain M, Lin D, Saad F, Vapiwala N, Chapin BF, Sandler H, et al. Newly Diagnosed High-Risk Prostate Cancer in an Era of Rapidly Evolving New Imaging: How Do We Treat? Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 2021;39(1): 13–16. https://doi.org/10.1200/JCO.20.02268.
Gillessen S, Bossi A, Davis ID, De Bono J, Fizazi K, James ND, et al. Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022. European Urology. 2023;83(3): 267–293. https://doi.org/10.1016/j.eururo.2022.11.002.
Salomon L, Saint F, Anastasiadis AG, Sebe P, Chopin D, Abbou CC. Combined reporting of cancer control and functional results of radical prostatectomy. European Urology. 2003;44(6): 656–660. https://doi.org/10.1016/j.eururo.2003.09.009.
Patel VR, Abdul-Muhsin HM, Schatloff O, Coelho RF, Valero R, Ko YH, et al. Critical review of ‘pentafecta’ outcomes after robot-assisted laparoscopic prostatectomy in high-volume centres. BJU international. 2011;108(6 Pt 2): 1007–1017. https://doi.org/10.1111/j.1464-410X.2011.10521.x.
Srougi V, Bessa J, Baghdadi M, Nunes-Silva I, da Costa JB, Garcia-Barreras S, et al. Surgical method influences specimen margins and biochemical recurrence during radical prostatectomy for high-risk prostate cancer: a systematic review and meta-analysis. World Journal of Urology. 2017;35(10): 1481–1488. https://doi.org/10.1007/s00345-017-2021-9.
Adam M, Tennstedt P, Lanwehr D, Tilki D, Steuber T, Beyer B, et al. Functional Outcomes and Quality of Life After Radical Prostatectomy Only Versus a Combination of Prostatectomy with Radiation and Hormonal Therapy. European Urology. 2017;71(3): 330–336. https://doi.org/10.1016/j.eururo.2016.11.015.
Emam A, Hermann G, Attwood K, Ji W, James G, Kuettel M, et al. Oncologic outcome of radical prostatectomy versus radiotherapy as primary treatment for high and very high risk localized prostate cancer. The Prostate. 2021;81(4): 223–230. https://doi.org/10.1002/pros.24089.
Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourology and Urodynamics. 2004;23(4): 322–330. https://doi.org/10.1002/nau.20041.
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. International Journal of Impotence Research. 1999;11(6): 319–326. https://doi.org/10.1038/sj.ijir.3900472.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery. 2004;240(2): 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae.
Wang Z, Ni Y, Chen J, Sun G, Zhang X, Zhao J, et al. The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis. World Journal of Surgical Oncology. 2020;18(1): 42. https://doi.org/10.1186/s12957-020-01824-9.
Gillessen S, Bossi A, Davis ID, de Bono J, Fizazi K, James ND, et al. Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022. European Urology. 2023;83(3): 267–293. https://doi.org/10.1016/j.eururo.2022.11.002.
Bastian PJ, Gonzalgo ML, Aronson WJ, Terris MK, Kane CJ, Amling CL, et al. Clinical and pathologic outcome after radical prostatectomy for prostate cancer patients with a preoperative Gleason sum of 8 to 10. Cancer. 2006;107(6): 1265–1272. https://doi.org/10.1002/cncr.22116.
Matulay JT, DeCastro GJ. Radical Prostatectomy for High-risk Localized or Node-Positive Prostate Cancer: Removing the Primary. Current Urology Reports. 2017;18(7): 53. https://doi.org/10.1007/s11934-017-0703-x.
Chang K, Qin XJ, Zhang HL, Dai B, Zhu Y, Shi GH, et al. Comparison of two adjuvant hormone therapy regimens in patients with high-risk localized prostate cancer after radical prostatectomy: primary results of study CU1005. Asian Journal of Andrology. 2016;18(3): 452–455. https://doi.org/10.4103/1008-682X.160884.
Jazayeri SB, Weissman B, Samadi DB. Outcomes following robotic-assisted laparoscopic prostatectomy: Pentafecta and Trifecta achievements. Minerva Urology and Nephrology. 2018;70(1). https://doi.org/10.23736/S0393-2249.17.02909-5.
Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ, Blute ML. Mayo Clinic Validation of the D’Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. Journal of Urology. 2008;179(4): 1354–1361. https://doi.org/10.1016/j.juro.2007.11.061.
Cao L, Yang Z, Qi L, Chen M. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine. 2019;98(22): e15770. https://doi.org/10.1097/MD.0000000000015770.
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