评估机器人辅助单孔腹膜外根治性前列腺切除术（RA-SPERP）在高危前列腺癌患者中的瘤控效果，探讨影响RA-SPERP瘤控效果的风险因素。

回顾性纳入2020年1月至2023年7月于上海交通大学医学院附属仁济医院行RA-SPERP的高危前列腺癌患者共94例，患者中位年龄及PSA中位数分别为70岁和49.8 ng/ml，所有患者均为高危前列腺癌（PSA>20 ng/ml或GS>7或cT_2c；任何PSA，任何GS，cT_3～4或cN+）。建立腹膜外通道后，安置Lagiport套件，连接da Vinci Si系统后进行前入路腹膜外根治性前列腺切除术。以根治病理的切缘阳性率和术后6周PSA是否达到根治水平作为RA-SPERP的瘤控效果指标，使用Logistic回归方法分析影响瘤控效果的因素。

所有患者均顺利完成RA-SPERP，无中转腹腔镜或开放手术。病理报告提示切缘阳性11例（11.70%），术后6周复诊检查PSA未达根治标准（PSA≥0.2 ng/ml）共14例（14.89%）。Logistic回归的结果显示，切缘阳性事件与术前较高的T分期有关，其OR=2.450；术后6周PSA未达根治标准事件，则与初诊PSA、前列腺穿刺的国际泌尿病理协会（ISUP）分级、术前T分期及淋巴结转移情况均有关，且各自变量的OR值均>1，由此建立预测术后PSA无法下降到根治水平的列线图。

高危前列腺癌患者实施RA-SPERP安全可行，手术的瘤控效果可靠。术前细致评估个体的肿瘤部位与肿瘤负荷是降低切缘阳性率及避免术后PSA无法降至根治水平的关键。

To evaluate the tumor control effect of robotic-assisted single port extraperitoneal radical prostatectomy (RA-SPERP) in high-risk prostate cancer patients, and explore the risk factors affecting the tumor control effect of RA-SPERP.

A total of 94 high-risk prostate cancer patients who underwent RA-SPERP in Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to July 2023 were retrospectively included. The median age and PSA of the patients were 70 years and 49.8 ng/ml, respectively. All patients were high risk prostate cancer (PSA>20 µg/lor Gleason score >7 or cT ≥2c), of which 44 were locally advanced tumors (any PSA, any Gleason score; cT₃-T₄ or cN+). After establishing an extraperitoneal channel, place the Lagiport and connect to the da Vinci Si system. The tumor control effect of RA-SPERP was evaluated by the rate of positive surgical margins on pathology and whether PSA persistent at 6 weeks after surgery. Logistic regression analysis was used to analyze the factors affecting tumor control.

All patients successfully completed RA-SPERP without any conversion to laparoscopic or open surgery. Pathology reports showed positive margins in 11 cases(11.70%) and lymph node metastasis in 22 cases (23.40%). A total of 14 cases (14.89%) underwent follow-up examination at 6 weeks post-surgery with PSA ≥0.2 ng/ml. The results of Logistic regression indicate that positive surgical margin event is related to the level of preoperative T staging, with an OR of 2.450. For the event PSA persistent at 6 weeks after surgery, which is related to the initial diagnosis of PSA, International Society of Urological Pathology (ISUP) grade of prostate biopsy, clinical T staging, and lymph node metastasis, with OR values all >1. The nomogram for judging PSA persistent was established based on these four factors.

RA-SPERP is safe and feasible for high-risk prostate cancer patients, and the tumor control effect of surgery is reliable. Preoperative assessment of individual tumor location and tumor burden is the key to reducing the rate of positive surgical margins and avoiding the PSA persistent after surgery.