Arai Y, Egawa S, Tobisu K, Sagiyama K, Sumiyoshi Y, Hashine K, Kawakita M, Matsuda T, Matsumoto K, Fujimoto H, Okada T, Kakehi Y, Terachi T, Ogawa O
Departments of Urology, Kurashiki Central Hospital, Kurashiki, Japan.
BJU Int. 2000 Feb;85(3):287-94. doi: 10.1046/j.1464-410x.2000.00468.x.
To assess the time trends, morbidity and mortality of contemporary anatomical radical retropubic prostatectomy (RRP) in a multi-institutional study in Japan, where RRP has become more popular in the last decade.
Between January 1991 and August 1998, 638 patients underwent RRP at seven urological centres in Japan. Major complications (within 30 days of surgery) and the 30-day mortality were reviewed retrospectively. Of the patients, 12.9% were < 60 years old, 56.3% were 60-69 years old and 30.9% were >/= 70 years old (median age 67). Results The number of RRPs increased markedly, by more than sevenfold, from 1991-92 to 1996-97, mainly because there were more patients undergoing RRP in their sixth decade. The contribution of T1c disease increased in absolute and relative terms, from 13.9% in 1991-92 to 37.9% in 1997-98. Over time, the mean blood loss and the allogeneic transfusion rate decreased steadily. There was a trend toward more favourable outcomes for pathological variables (an increased percentage of organ-confined disease, decreased margin positivity and a decreased incidence of positive lymph node metastasis). The most common complications were wound-related (7.5%), or anastomotic leakage (4.1%). Major cardiopulmonary complications occurred in only two patients (0.31%, both pulmonary embolisms). One patient died from cerebral haemorrhage within 30 days of surgery, giving a mortality rate of 0.16%.
s This study indicates a trend towards selecting patients most likely to benefit from RRP. Although the procedure is technically demanding, it can have an acceptably low rate of early complications, little mortality and need for allogeneic transfusion. The assessment of morbidity suggests a lower incidence of catastrophic thrombo-embolic and cardiac complications in Japanese patients than in Western men. The present data may be useful in decision-analysis models evaluating the role of therapy for Asian men with early-stage prostate cancer.
在一项日本多机构研究中评估当代耻骨后根治性前列腺切除术（RRP）的时间趋势、发病率和死亡率，在日本RRP在过去十年中变得更受欢迎。
1991年1月至1998年8月期间，638例患者在日本7个泌尿外科中心接受了RRP。回顾性分析主要并发症（术后30天内）和30天死亡率。患者中，12.9%年龄<60岁，56.3%年龄在60 - 69岁，30.9%年龄≥70岁（中位年龄67岁）。结果RRP的数量从1991 - 1992年到1996 - 1997年显著增加，增加了七倍多，主要是因为在第六个十年接受RRP的患者增多。T1c疾病的贡献在绝对和相对方面均有所增加，从1991 - 1992年的13.9%增至1997 - 1998年的37.9%。随着时间推移，平均失血量和异体输血率稳步下降。病理变量有更有利结果的趋势（器官局限性疾病百分比增加、切缘阳性率降低以及阳性淋巴结转移发生率降低）。最常见的并发症是伤口相关（7.5%）或吻合口漏（4.1%）。仅2例患者发生主要心肺并发症（0.31%，均为肺栓塞）。1例患者在术后30天内死于脑出血，死亡率为0.16%。
本研究表明有选择最可能从RRP中获益患者的趋势。尽管该手术技术要求高，但早期并发症发生率可接受地低，死亡率低且异体输血需求少。发病率评估表明日本患者灾难性血栓栓塞和心脏并发症的发生率低于西方男性。目前的数据可能有助于评估早期前列腺癌亚洲男性治疗作用的决策分析模型。
