Link Brian A, Nelson Rebecca, Josephson David Y, Yoshida Jeffrey S, Crocitto Laura E, Kawachi Mark H, Wilson Timothy G
Department of Urology, City of Hope, Duarte, California, USA.
J Urol. 2008 Sep;180(3):928-32. doi: 10.1016/j.juro.2008.05.029. Epub 2008 Jul 17.
We determined whether prostate weight has an impact on the pathological and operative outcomes of robot assisted laparoscopic radical prostatectomy.
We reviewed the records of 1,847 consecutive patients who underwent robot assisted laparoscopic radical prostatectomy at our institution. Variables were compared across quartile distributions of prostate size as defined by weight, including group 1-less than 30 gm, group 2-30 to 49.9, group 3-50 to 69.9 and group 4-70 or greater. Factors assessed in this analysis were patient age, body mass index, prostate specific antigen, Gleason score, pathological stage, margin status, operative time, blood loss, transfusion rate, length of stay and rehospitalization rate.
Patients with a larger prostate (group 4) were older (mean age 66.2 years), had higher pretreatment prostate specific antigen (median 6.5 ng/ml), lower Gleason score (mean 6.3), longer operative time (mean 3.2 hours), higher estimated blood loss (median 250 cc) and longer hospital stay (p = 0.0002). There was a trend toward higher risk disease based on D'Amico risk stratification and positive margin status in group 1, although evidence of extracapsular extension was more common in groups 2 and 3. There was no association between prostate size and body mass index, lymph node status, blood transfusion rate, seminal vesicle involvement and rehospitalization rate.
Robot assisted laparoscopic radical prostatectomy in patients with an enlarged prostate is feasible with slightly longer operative time, urinary leakage rates and hospital stay. Pathologically larger prostates are generally associated with lower Gleason score and risk group stratification. One-year continence rates and biochemical recurrence rates are similar across all groups.
我们确定前列腺重量是否对机器人辅助腹腔镜根治性前列腺切除术的病理及手术结果有影响。
我们回顾了在我院连续接受机器人辅助腹腔镜根治性前列腺切除术的1847例患者的记录。根据前列腺重量定义的四分位数分布对变量进行比较，包括第1组-小于30克，第2组-30至49.9克，第3组-50至69.9克，第4组-70克及以上。本分析评估的因素包括患者年龄、体重指数、前列腺特异性抗原、Gleason评分、病理分期、切缘状态、手术时间、失血量、输血率、住院时间和再次住院率。
前列腺较大的患者（第4组）年龄较大（平均年龄66.2岁），术前前列腺特异性抗原较高（中位数6.5纳克/毫升），Gleason评分较低（平均6.3），手术时间较长（平均3.2小时），估计失血量较高（中位数250毫升），住院时间较长（p = 0.0002）。根据达米科风险分层，第1组疾病风险有升高趋势且切缘阳性，但包膜外侵犯在第2组和第3组更常见。前列腺大小与体重指数、淋巴结状态、输血率、精囊受累及再次住院率之间无关联。
对于前列腺增大的患者，机器人辅助腹腔镜根治性前列腺切除术是可行的，只是手术时间、尿漏率和住院时间稍长。病理上较大的前列腺通常与较低的Gleason评分和风险组分层相关。所有组的一年控尿率和生化复发率相似。
