Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
Urol Oncol. 2012 Sep;30(5):569-76. doi: 10.1016/j.urolonc.2010.06.009. Epub 2010 Sep 6.
To determine the effect of minimally invasive radical prostatectomy (MIRP) surgeon volume on outcomes, and correlate with those of open radical prostatectomy retropubic (ORP).
Observational population-based study of 8,831 men undergoing MIRP and ORP by 1,457 low, medium, and high volume surgeons from SEER-Medicare linked data from 2003 to 2007. After stratifying by surgeon ORP and MIRP volume, the following outcomes were studied: length of stay, transfusions, post-operative 30-day and anastomotic stricture complications, and use of additional cancer therapies.
Men undergoing MIRP with high and medium vs. low volume surgeons were less likely to require additional cancer therapies (4.5% and 4.7% vs. 7%, P = 0.020). Similarly, men undergoing ORP with high vs. medium and low volume surgeons were less likely to require additional cancer therapies (5.7% vs. 6.8% and 7.1%, P = 0.044). Men undergoing ORP with high vs. medium and low volume surgeons experienced shorter lengths of stay (2.9 vs. 3.3 and 3.6 days, P < 0.001), and fewer transfusions (15.4% vs. 21.3% and 22.7%, P = 0.017), 30-day complications (18.4% vs. 25.6% and 25.7%, P < 0.001), and anastomotic strictures (10.1% vs. 15.6% and 16.3%, P = 0.003). However, MIRP surgeon volume did not affect these outcomes.
Men undergoing MIRP or ORP with high volume surgeons were less likely to require additional cancer therapies. Additionally, patients of high volume ORP surgeons were more likely to experience shorter hospital stays, fewer transfusions, 30-day complications, and anastomotic strictures, while MIRP surgeon volume did not affect these peri-operative outcomes.
确定微创根治性前列腺切除术（MIRP）术者数量对治疗结果的影响，并与开放根治性前列腺切除术耻骨后（ORP）的结果进行比较。
本研究为基于人群的观察性研究，纳入了 2003 年至 2007 年 SEER-Medicare 相关数据中 8831 名接受 MIRP 和 ORP 的患者，术者共 1457 名，分为低、中、高手术量组。在按术者 ORP 和 MIRP 手术量分层后，研究了以下结果：住院时间、输血、术后 30 天和吻合口狭窄并发症以及额外癌症治疗的使用。
与低手术量组相比，高和中手术量组行 MIRP 的患者更不可能需要额外的癌症治疗（4.5%和 4.7%比 7%，P=0.020）。同样，高手术量组行 ORP 的患者与中手术量和低手术量组相比，更不可能需要额外的癌症治疗（5.7%比 6.8%和 7.1%，P=0.044）。与中手术量和低手术量组相比，高手术量组行 ORP 的患者住院时间更短（2.9 比 3.3 和 3.6 天，P<0.001），输血更少（15.4%比 21.3%和 22.7%，P=0.017），30 天并发症更少（18.4%比 25.6%和 25.7%，P<0.001），吻合口狭窄更少（10.1%比 15.6%和 16.3%，P=0.003）。然而，MIRP 术者数量并未影响这些结果。
接受高手术量术者 MIRP 或 ORP 的患者更不可能需要额外的癌症治疗。此外，高手术量 ORP 术者的患者更有可能经历较短的住院时间、较少的输血、30 天并发症和吻合口狭窄，而 MIRP 术者数量并未影响这些围手术期结果。
