Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Stockholm, Sweden.
Eur Urol. 2015 Apr;67(4):660-70. doi: 10.1016/j.eururo.2014.09.036. Epub 2014 Oct 11.
Robot-assisted laparoscopic radical prostatectomy has become a widespread technique despite a lack of randomised trials showing its superiority over open radical prostatectomy.
To compare in-hospital characteristics and patient-reported outcomes at 3 mo between robot-assisted laparoscopic and open retropubic radical prostatectomy.
DESIGN, SETTING, AND PARTICIPANTS: A prospective, controlled trial was performed of all men who underwent radical prostatectomy at 14 participating centres. Validated patient questionnaires were collected at baseline and after 3 mo by independent health-care researchers.
The difference in outcome between the two treatment groups were analysed using logistic regression analysis, with adjustment for identified confounders.
Questionnaires were received from 2506 (95%) patients. The robot-assisted surgery group had less perioperative bleeding (185 vs 683 ml, p<0.001) and shorter hospital stay (3.3 vs 4.1 d, p<0.001) than the open surgery group. Operating time was shorter with the open technique (103 vs 175 min, p<0.001) compared with the robot-assisted technique. Reoperation during initial hospital stay was more frequent after open surgery after adjusting for tumour characteristics and lymph node dissection (1.6% vs 0.7%, odds ratio [OR] 0.31, 95% confidence interval [CI 95%] 0.11-0.90). Men who underwent open surgery were more likely to seek healthcare (for one or more of 22 specified disorders identified prestudy) compared to men in the robot-assisted surgery group (p=0.03). It was more common to seek healthcare for cardiovascular reasons in the open surgery group than in the robot-assisted surgery group, after adjusting for nontumour and tumour-specific confounders, (7.9% vs 5.8%, OR 0.63, CI 95% 0.42-0.94). The readmittance rate was not statistically different between the groups. A limitation of the study is the lack of a standardised tool for the assessment of the adverse events.
This large prospective study confirms previous findings that robot-assisted laparoscopic radical prostatectomy is a safe procedure with some short-term advantages compared to open surgery. Whether these advantages also include long-term morbidity and are related to acceptable costs remain to be studied.
We compare patient-reported outcomes between two commonly used surgical techniques. Our results show that the choice of surgical technique may influence short-term outcomes.
尽管缺乏随机试验表明机器人辅助腹腔镜根治性前列腺切除术优于开放根治性前列腺切除术，但该技术已广泛应用。
比较机器人辅助腹腔镜与开放经耻骨后根治性前列腺切除术的住院期间特征和 3 个月时的患者报告结局。
设计、设置和参与者：对 14 个参与中心的所有接受根治性前列腺切除术的男性进行了前瞻性、对照试验。独立的医疗保健研究人员在基线和 3 个月后收集了经过验证的患者问卷。
使用逻辑回归分析比较两组治疗结果的差异，并对确定的混杂因素进行调整。
共收到 2506 名（95%）患者的问卷。与开放手术组相比，机器人辅助手术组术中出血量较少（185 与 683ml，p<0.001），住院时间较短（3.3 与 4.1d，p<0.001）。与机器人辅助技术相比，开放技术的手术时间更短（103 与 175min，p<0.001）。调整肿瘤特征和淋巴结清扫后，开放手术组初次住院期间再次手术的频率更高（1.6%比 0.7%，比值比[OR]0.31，95%置信区间[CI 95%]0.11-0.90）。与机器人辅助手术组相比，接受开放手术的男性更有可能因 22 种特定疾病之一或多种疾病（研究前确定的疾病）寻求医疗保健（p=0.03）。调整非肿瘤和肿瘤特异性混杂因素后，开放手术组比机器人辅助手术组更常见因心血管原因寻求医疗保健（7.9%比 5.8%，OR0.63，CI95%0.42-0.94）。两组的再入院率无统计学差异。该研究的局限性在于缺乏评估不良事件的标准化工具。
这项大型前瞻性研究证实了之前的发现，即与开放手术相比，机器人辅助腹腔镜根治性前列腺切除术是一种安全的手术方法，具有一些短期优势。这些优势是否也包括长期发病率，以及是否与可接受的成本有关，仍有待研究。
我们比较了两种常用手术技术的患者报告结局。我们的结果表明，手术技术的选择可能会影响短期结局。
