医学
前列腺切除术
手术切缘
前列腺
根治性耻骨后前列腺切除术
腹腔镜检查
原卟啉IX
前瞻性队列研究
泌尿科
外科
内科学
光动力疗法
癌症
切除术
有机化学
化学
作者
C. Adam,Georg Salomon,Sebastian Walther,Dirk Zaak,Wael Khoder,Armin Becker,Oliver Reich,Andreas Blana,Roman Ganzer,Stefan Denzinger,G. Popken,Ronald Sroka,Ruth Knüchel‐Clarke,Jens Köllermann,Guido Sauter,Arndt Hartmann,Simone Bertz,Markus Graefen,Hartwig Huland,Wolf F. Wieland,Christian G. Stief
标识
DOI:10.1016/j.eururo.2009.02.027
摘要
Surgical margin status after radical prostatectomy (RP) is a significant risk factor for tumour recurrence. It is an intriguing concept to find a fluorescence marker for photodynamic diagnosis (PDD) to make tumour margins visible during surgery. To investigate the feasibility of identification of positive surgical margins (PSM) during open retropubic or endoscopic extraperitoneal RP by 5-aminolevulinic acid (5-ALA)–induced protoporphyrin IX (PpIX) to enhance surgical radicality. Thirty-nine patients (Gleason score 6–10, prostate-specific antigen [PSA] 2.3–120 ng/ml) received 20 mg/kg of body weight of 5-ALA orally and underwent RP (24 endoscopic extraperitoneal, 15 open retropubic). A PDD-suitable laparoscopy optic (Karl-Storz GmbH, Tuttlingen, Germany) with a yellow long-pass filter was coupled to a fibre-optic light cord with an excitation light source (380–420 nm, D-Light, Karl-Storz GmbH, Tuttlingen, Germany) for fluorescence excitation of PpIX and to a PDD-suitable camera for video and photo documentation by the AIDA DVD system (Karl-Storz GmbH, Tuttlingen, Germany). There were more false-negative cases in the open group (four vs two) than in the endoscopic group but more false-positive cases in the endoscopic group (two vs none) than in the open group. The overall sensitivity and specificity were 56% and 91.6%, respectively. The sensitivity of the endoscopic cases was much higher (75% vs 38%) than for the open cases, while the specificity was higher for the open group (88.2% vs 100%). PDD with 5-ALA–induced PpIX during RP might be a feasible and effective method for reducing the rate of PSM. The technique seems to be more practicable during endoscopic RP rather than open RP. Further clinical studies with higher patient volumes and further development of the technique seem justified. EudraCT: 2005-004406-93.
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