Satkunasivam Raj, Wallis Christopher J D, Byrne James, Hoffman Azik, Cheung Douglas C, Kulkarni Girish S, Nathens Avery B, Nam Robert K
Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2016 Nov-Dec;10(11-12):423-429. doi: 10.5489/cuaj.3939.
We sought to determine whether patients undergoing radical prostatectomy (RP) in the context of disseminated cancer have higher 30-day complications.
We conducted a retrospective cohort study of the National Surgical Quality Improvement Program (NSQIP) database. Men undergoing RP (from January 1, 2005 to December 31, 2014) for prostate cancer were identified and stratified by presence (n=97) or absence (n=27 868) of disseminated cancer. The primary outcome was major complications (death, re-operation, cardiac or neurologic events) within 30 days of surgery. Secondary outcomes included pulmonary, infectious, venous thromboembolic, and bleeding complications; prolonged length of stay; and concomitant procedures (bowel-related, cystectomy, urinary diversion, and major ureteric reconstruction). Odds ratios (OR) for each complication were calculated using univariable logistic regression.
We did not identify a difference in major complication rates (OR 2.26, 95% confidence interval [CI] 0.71-7.16). Patients with disseminated cancer had increased risk of venous thromboembolic events (OR 3.30, 95% CI 1.04-10.48) and transfusion (OR 2.45, 95% CI 1.18-5.05), but similar odds of pulmonary and infectious complications and length of stay. Bowel procedures were rare, however, a significantly higher proportion of patients with disseminated cancer required bowel procedures (2.1% vs. 0.3%; p=0.03). Patients with disseminated cancer undergoing RP had greater comorbidities and higher predicted probability of morbidity and mortality. This study is limited by its retrospective design, lack of cancer-specific variables, and prostatectomy-specific complications.
RP in the context of disseminated cancer may be associated with increased perioperative complications. Caution should be exercised in embarking on this practice outside of clinical trials.
我们试图确定在患有播散性癌症的情况下接受根治性前列腺切除术（RP）的患者30天并发症发生率是否更高。
我们对国家外科质量改进计划（NSQIP）数据库进行了一项回顾性队列研究。确定了因前列腺癌接受RP（2005年1月1日至2014年12月31日）的男性患者，并根据是否存在播散性癌症分为两组（存在组n = 97，不存在组n = 27868）。主要结局是术后30天内的主要并发症（死亡、再次手术、心脏或神经事件）。次要结局包括肺部、感染性、静脉血栓栓塞性和出血性并发症；住院时间延长；以及伴随手术（肠道相关、膀胱切除术、尿流改道和主要输尿管重建）。使用单变量逻辑回归计算每种并发症的比值比（OR）。
我们未发现主要并发症发生率存在差异（OR 2.26，95%置信区间[CI] 0.71 - 7.16）。患有播散性癌症的患者发生静脉血栓栓塞事件（OR 3.30，95% CI 1.04 - 10.48）和输血（OR 2.45，95% CI 1.18 - 5.05）的风险增加，但肺部和感染性并发症及住院时间的比值相似。肠道手术很少见，然而，患有播散性癌症的患者需要进行肠道手术的比例显著更高（2.1%对0.3%；p = 0.03）。接受RP的患有播散性癌症的患者合并症更多，发病和死亡的预测概率更高。本研究受其回顾性设计、缺乏癌症特异性变量以及前列腺切除术特异性并发症的限制。
在患有播散性癌症的情况下进行RP可能与围手术期并发症增加有关。在临床试验之外开展这种手术时应谨慎。
