Weiner Adam B, Murthy Prithvi, Richards Kyle A, Patel Sanjay G, Eggener Scott E
Section of Urology, University of Chicago Medical Center, Chicago, Illinois.
Section of Urology, University of Chicago Medical Center, Chicago, Illinois; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Urol. 2015 Mar;193(3):826-31. doi: 10.1016/j.juro.2014.09.113. Epub 2015 Jan 26.
We used population based data to measure the rates and risk factors of open conversion during minimally invasive radical prostatectomy in the United States.
We retrospectively analyzed the records of 87,415 patients in the NCDB who underwent minimally invasive radical prostatectomy between 2010 and 2011. We compared surgical outcomes and treatment facility characteristics between converted and nonconverted cases. Multivariable analysis was done to evaluate conversion risk factors.
There were 82,338 robot-assisted (94%) and 5,077 laparoscopic (6%) radical prostatectomies, and 1,080 conversions (1.2%). Fewer robot-assisted cases were converted than laparoscopic cases (0.9% vs 6.5%, p <0.001). The median yearly treatment facility volume of minimally invasive radical prostatectomy was 32 (IQR 10-72). Patients who underwent conversion were more likely to be rehospitalized within 30 days (4.4% vs 2.7%, p = 0.002) and have a postoperative hospital stay of greater than 2 days (40.4% vs 15.1%, p <0.001) than those without conversion. Facilities in the lowest quartile of the yearly volume of the minimally invasive procedure represented 3.8% of minimally invasive radical prostatectomies but accounted for 22.9% of conversions. The second, third and fourth quartiles of yearly treatment facility minimally invasive volume predicted a lower likelihood of conversion compared to the first quartile (each p <0.001). Facility type (eg academic or community) did not predict conversion. Black race (vs white OR 1.52, 95% CI 1.24-1.86, p <0.001) and laparoscopic radical prostatectomy (OR 4.68, 95% CI 3.79-5.78, p <0.001) predicted higher odds of conversion.
Open conversion during minimally invasive radical prostatectomy is a rare event. However, it is significantly more likely for pure laparoscopic surgery, in black men and at low volume facilities. Facility type did not affect conversion rates.
我们利用基于人群的数据来衡量美国微创根治性前列腺切除术中开放转换的发生率及风险因素。
我们回顾性分析了国家癌症数据库（NCDB）中87415例在2010年至2011年间接受微创根治性前列腺切除术患者的记录。我们比较了转换组与未转换组的手术结果及治疗机构特征。进行多变量分析以评估转换的风险因素。
共有82338例机器人辅助根治性前列腺切除术（94%）和5077例腹腔镜根治性前列腺切除术（6%），其中1080例发生转换（1.2%）。机器人辅助手术的转换例数少于腹腔镜手术（0.9%对6.5%，p<0.001）。微创根治性前列腺切除术的治疗机构年手术量中位数为32例（四分位间距10 - 72例）。与未转换患者相比，转换患者在30天内再次住院的可能性更高（4.4%对2.7%，p = 0.002），术后住院时间超过2天的可能性也更高（40.4%对15.1%，p<0.001）。微创操作年手术量处于最低四分位数的机构进行的微创根治性前列腺切除术占3.8%，但转换病例占22.9%。与第一四分位数相比，治疗机构微创年手术量的第二、第三和第四四分位数预测转换可能性较低（各p<0.001）。机构类型（如学术型或社区型）不能预测转换情况。黑人种族（与白人相比，比值比1.52，95%置信区间1.24 - 1.86，p<0.001）和腹腔镜根治性前列腺切除术（比值比4.68，95%置信区间3.79 - 5.78，p<0.001）预测转换几率更高。
微创根治性前列腺切除术中的开放转换是罕见事件。然而，纯腹腔镜手术、黑人男性以及手术量少的机构发生开放转换的可能性显著更高。机构类型不影响转换率。
