既往有腹部或盆腔手术史情况下的腹膜外与经腹膜机器人辅助根治性前列腺切除术

Extraperitoneal vs Transperitoneal Robot-Assisted Radical Prostatectomy in the Setting of Prior Abdominal or Pelvic Surgery.

作者信息

Horovitz David, Feng Changyong, Messing Edward M, Joseph Jean V

机构信息

1 Department of Urology, University of Rochester Medical Center , Rochester, New York.

2 Department of Biostatistics and Computational Biology, University of Rochester Medical Center , Rochester, New York.

出版信息

J Endourol. 2017 Apr;31(4):366-373. doi: 10.1089/end.2016.0706. Epub 2017 Mar 1.

DOI:10.1089/end.2016.0706

PMID:28073298

Abstract

INTRODUCTION

During robot-assisted radical prostatectomy (RARP), the prostate may be approached extraperiteoneally (extraperitoneal robot-assisted radical prostatectomy [eRARP]) or transperitoneally (transperitoneal robot-assisted radical prostatectomy [tRARP]). The former avoids the abdominal cavity, which might be of benefit in patients who have had prior abdominal or pelvic surgery (PAPS). Our objective was to compare the outcomes of patients with PAPS undergoing either technique.

METHODS

A retrospective review of patients treated with RARP from July 1, 2003 to December 31, 2014 with a minimum follow-up of 3 months was undertaken. Of 2927 patients, 620 were identified as having undergone RARP (without concomitant unrelated procedures) and PAPS (excluding patients with prior inguinal hernia repair with mesh or unclear surgical histories) for prostate adenocarcinoma without prior pelvic radiotherapy. Of these, 340 patients underwent eRARP and 280 patients underwent tRARP.

RESULTS

Patients in the eRARP group were younger (61.04 years vs 62.32, p = 0.02), had a higher body mass index (29.65 vs 28.98, p = 0.09), lower American Society of Anesthesiologists scores (p = 0.03), and lower D'Amico risk classification disease (p < 0.0001). The two groups had similar rates of 1, 2, and >2 PAPS. On univariate analysis, the eRARP group had lower operative time (188.96 minutes vs 197.92 minutes, p = 0.003), extensive lysis of adhesions (0.9% vs 14.3%, p < 0.0001), length of hospital stay (LOS) (1.13 days ±0.45 vs 1.33 day ±1.08, p = 0.003), and higher estimated blood loss (210.74 mL vs 190.79 mL, p = 0.06). The eRARP group had a lower rate of gastrointestinal complications (0% vs 3.21%, p = 0.0007), a trend toward lower early post-operative complications (8.53% vs 12.86%, p = 0.08), and lower overall complications (9.41% vs 15%, p = 0.03). In regression analysis with model selection, only LOS was lower in the eRARP group (p = 0.02).

CONCLUSIONS

Both methods are safe in patients with prior abdominal surgeries. A lower incidence of gastrointestinal complications and a shorter length of stay were noted in the extraperitoneal cohort.

摘要

引言

在机器人辅助根治性前列腺切除术（RARP）中，前列腺可通过腹膜外途径（腹膜外机器人辅助根治性前列腺切除术[eRARP]）或经腹途径（经腹机器人辅助根治性前列腺切除术[tRARP]）进行处理。前者避免进入腹腔，这可能对既往有腹部或盆腔手术史（PAPS）的患者有益。我们的目的是比较接受这两种手术的PAPS患者的手术结果。

方法

对2003年7月1日至2014年12月31日接受RARP治疗且至少随访3个月的患者进行回顾性研究。在2927例患者中，620例被确定为因前列腺腺癌接受了RARP（不包括同期无关手术）且有PAPS（不包括既往有网片修补腹股沟疝或手术史不明确的患者），且术前未接受盆腔放疗。其中，340例患者接受了eRARP，280例患者接受了tRARP。

结果

eRARP组患者更年轻（61.04岁对62.32岁，p = 0.02），体重指数更高（29.65对28.98，p = 0.09），美国麻醉医师协会评分更低（p = 0.03），D'Amico风险分类疾病更低（p < 0.0001）。两组1次、2次及>2次PAPS的发生率相似。单因素分析显示，eRARP组手术时间更短（188.96分钟对197.92分钟，p = 0.003），粘连广泛松解率更低（0.9%对14.3%，p < 0.0001），住院时间（LOS）更短（1.13天±0.45对1.33天±1.08，p = 0.003），估计失血量更高（210.74 mL对190.79 mL，p = 0.06）。eRARP组胃肠道并发症发生率更低（0%对3.21%，p = 0.0007），术后早期并发症有降低趋势（8.53%对12.86%，p = 0.08），总体并发症更低（9.41%对15%，p = 0.03）。在模型选择的回归分析中，仅eRARP组的LOS更短（p = 0.02）。