Rodriguez Alejandro R, Kapoor Rachna, Pow-Sang Julio M
Department of Interdisciplinary Oncology, Division of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida 33612-9497, USA.
J Urol. 2007 May;177(5):1765-70. doi: 10.1016/j.juro.2007.01.034.
Patients with a high body mass index, previous pelvic surgery or large prostate size are not considered ideal candidates for radical prostatectomy. We assessed the impact of body mass index, previous pelvic surgery and prostate weight on perioperative and pathological outcomes in patients treated exclusively with laparoscopic extraperitoneal radical prostatectomy.
From January 2004 to May 2005, 300 patients underwent laparoscopic extraperitoneal radical prostatectomy. Patients were divided into groups, including body mass index groups 1 (25 kg/m(2) or less), 2 (25.1 to 30), 3 (30.1 to 36) and 4 (greater than 36); prostate weight groups 1 (20 gm or less), 2 (20.1 to 40), 3 (40.1 to 60) and 4 (more than 60); and prior surgery groups 1 (no previous pelvic or prostatic surgery) and 2 (previous pelvic or prostatic surgery).
Logistic regression demonstrated that body mass index, large prostate size and previous pelvic surgery did not affect margin status. The Kruskal-Wallis test was performed to analyze if body mass index, large prostate size and previous pelvic surgery had an effect on perioperative variables. Only prostate weight correlated with a delay in Foley catheter removal (3 days, p=0.0005). The Wilcoxon rank sum test showed that patients with a higher body mass index had a slightly prolonged hospital stay (16 hours, p=0.02). Patients with a prostate of more than 40 gm had slightly increased blood loss (56 cc, p=0.03), which did not affect the transfusion rate.
Laparoscopic extraperitoneal radical prostatectomy can be performed in complex surgical cases without increased perioperative morbidity. Obese patients and those with a large prostate who prefer surgery as a treatment option for localized prostate cancer may benefit from the advantages that laparoscopic extraperitoneal radical prostatectomy offers.
体重指数高、既往有盆腔手术史或前列腺体积大的患者不被视为根治性前列腺切除术的理想候选人。我们评估了体重指数、既往盆腔手术和前列腺重量对仅接受腹腔镜腹膜外根治性前列腺切除术患者围手术期和病理结果的影响。
2004年1月至2005年5月，300例患者接受了腹腔镜腹膜外根治性前列腺切除术。患者被分为不同组，包括体重指数组1（25kg/m²或更低）、2（25.1至30）、3（30.1至36）和4（大于36）；前列腺重量组1（20g或更低）、2（20.1至40）、3（40.1至60）和4（超过60）；以及既往手术组1（无既往盆腔或前列腺手术）和2（既往有盆腔或前列腺手术）。
逻辑回归显示体重指数、前列腺体积大及既往盆腔手术不影响切缘状态。进行Kruskal-Wallis检验以分析体重指数、前列腺体积大及既往盆腔手术是否对围手术期变量有影响。仅前列腺重量与导尿管拔除延迟相关（3天，p=0.0005）。Wilcoxon秩和检验显示体重指数较高的患者住院时间略有延长（16小时，p=0.02）。前列腺重量超过40g的患者失血量略有增加（56cc，p=0.03），但这并未影响输血率。
腹腔镜腹膜外根治性前列腺切除术可在复杂手术病例中进行，且围手术期发病率不会增加。肥胖患者以及前列腺体积大且倾向于选择手术作为局限性前列腺癌治疗方案的患者可能会从腹腔镜腹膜外根治性前列腺切除术的优势中获益。
