Zorn Kevin C, Orvieto Marcelo A, Mikhail Albert A, Gofrit Ofer N, Lin Shang, Schaeffer Anthony J, Shalhav Arieh L, Zagaja Gregory P
Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Urology. 2007 Feb;69(2):300-5. doi: 10.1016/j.urology.2006.10.021.
To determine the effect of prostate weight (PW) on robotic laparoscopic radical prostatectomy (RLRP) outcomes. The effect of PW on surgical and pathologic outcomes has been reviewed in open and laparoscopic prostatectomy series. Little is known about its effects during RLRP.
From February 2003 to November 2005, 375 men underwent RLRP. Patients were divided into four groups on the basis of the pathologic PW: group 1, less than 30 g; group 2, 30 g or more to less than 50 g; group 3, 50 g or more to less than 80 g; and group 4, 80 g or larger. The groups were compared prospectively. Continence and sexual function were assessed using validated questionnaires.
Of the 375 patients, 20, 201, 123, and 31 had a PW of less than 30 g, 30 g or more to less than 50 g, 50 g or more to less than 80 g, and 80 g or larger, respectively. A significant difference was found in age and prostate-specific antigen values among the four groups (P <0.001). No significant differences in operative time, estimated blood loss, transfusion rate, hospital stay, length of catheterization, and complication incidence were observed among the four groups. The overall rate of positive surgical margins was significantly different among the groups (P = 0.002), demonstrating a trend of increasing positive surgical margins with a lower PW. Within the patients with Stage pT2, a significant increase in positive surgical margins was found with lower PWs (P = 0.026). The objective return of baseline and subjective sexual and urinary function, as determined by questionnaire scores, was not affected by the PW.
RLRP can be performed safely and with similar perioperative outcomes in men, regardless of the PW. We found a significant inverse relationship between surgical margin status and PW, specifically in those with Stage pT2 disease.
确定前列腺重量（PW）对机器人腹腔镜根治性前列腺切除术（RLRP）结果的影响。在开放性和腹腔镜前列腺切除术系列研究中，已对PW对手术和病理结果的影响进行了综述。关于其在RLRP期间的影响知之甚少。
2003年2月至2005年11月，375名男性接受了RLRP。根据病理PW将患者分为四组：第1组，小于30克；第2组，30克及以上至小于50克；第3组，50克及以上至小于80克；第4组，80克及以上。对各组进行前瞻性比较。使用经过验证的问卷评估控尿和性功能。
375例患者中，PW小于30克、30克及以上至小于50克、50克及以上至小于80克、80克及以上的分别有20例、201例、123例和31例。四组患者的年龄和前列腺特异性抗原值存在显著差异（P<0.001）。四组患者在手术时间、估计失血量、输血率、住院时间、导尿时间和并发症发生率方面未观察到显著差异。各组手术切缘阳性率存在显著差异（P = 0.002），显示出PW越低手术切缘阳性率增加的趋势。在pT2期患者中，PW越低手术切缘阳性率显著增加（P = 0.026）。根据问卷评分确定的基线客观恢复以及主观性功能和排尿功能不受PW影响。
无论PW如何，男性患者均可安全地进行RLRP，且围手术期结果相似。我们发现手术切缘状态与PW之间存在显著的负相关，特别是在pT2期疾病患者中。
