Pettus Joseph A, Masterson Timothy, Sokol Alexander, Cronin Angel M, Savage Caroline, Sandhu Jaspreet S, Mulhall John P, Scardino Peter T, Rabbani Farhang
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
J Urol. 2009 Sep;182(3):949-55. doi: 10.1016/j.juro.2009.05.029. Epub 2009 Jul 17.
We assessed the impact of prostate size on operative difficulty as measured by estimated blood loss, operating room time and positive surgical margins. In addition, we assessed the impact on biochemical recurrence and the functional outcomes of potency and continence at 1 year after radical prostatectomy as well as postoperative bladder neck contracture.
From 1998 to 2007, 3,067 men underwent radical prostatectomy by 1 of 5 dedicated prostate surgeons with no neoadjuvant or adjuvant therapy. Pathological specimen weight was used as a measure of prostate size. Cox proportional hazards and logistic regression analysis was used to study the association between specimen weight, and biochemical recurrence and surgical margin status, respectively, controlling for adverse pathological features. Continence and potency were analyzed controlling for age, nerve sparing status and surgical approach.
With increasing prostate size there was increased estimated blood loss (p = 0.013) and operative time (p = 0.004), and a decrease in positive surgical margins (84 of 632 [14%] for 40 gm or less, 99 of 862 [12%] for 41 to 50 gm, 78 of 842 [10%] for 51 to 65 gm, 68 of 731 [10%] for more than 65 gm, p <0.001). Biochemical recurrence was observed in 186 of 2,882 patients followed postoperatively and was not significantly associated with specimen weight (p = 0.3). Complete continence was observed in 1,165 of 1,422 patients (82%) and potency in 425 of 827 (51%) at 1 year. Specimen weight was not significantly associated with potency (p = 0.8), continence (p = 0.08) or bladder neck contracture (p = 0.22).
Prostate size does not appear to affect biochemical recurrence or 1-year functional results. However, estimated blood loss and operative time increased with larger prostate size, and positive surgical margins are more often observed in smaller glands.
我们评估了前列腺大小对手术难度的影响，手术难度通过估计失血量、手术时间和手术切缘阳性情况来衡量。此外，我们还评估了前列腺大小对根治性前列腺切除术后1年生化复发、性功能（勃起功能和控尿功能）以及术后膀胱颈挛缩的影响。
1998年至2007年期间，3067名男性由5名专门从事前列腺手术的外科医生之一进行了根治性前列腺切除术，未接受新辅助或辅助治疗。病理标本重量用作前列腺大小的衡量指标。分别采用Cox比例风险模型和逻辑回归分析来研究标本重量与生化复发及手术切缘状态之间的关联，并对不良病理特征进行校正。在对年龄、保留神经情况和手术方式进行校正的基础上，分析控尿功能和勃起功能。
随着前列腺体积增大，估计失血量增加（p = 0.013），手术时间延长（p = 0.004），手术切缘阳性率降低（前列腺重量40克及以下者，632例中有84例[14%]；41至50克者，862例中有99例[12%]；51至65克者，842例中有78例[10%]；超过65克者，731例中有68例[10%]，p <0.001）。术后随访的2882例患者中有186例出现生化复发，与标本重量无显著相关性（p = 0.3）。1年时，1422例患者中有1165例（82%）实现完全控尿，827例中有425例（51%）恢复勃起功能。标本重量与勃起功能（p = 0.8）、控尿功能（p = 0.08）或膀胱颈挛缩（p = 0.22）均无显著相关性。
前列腺大小似乎不影响生化复发或1年的功能结果。然而，随着前列腺体积增大，估计失血量和手术时间增加，较小腺体更常出现手术切缘阳性。
