Safavy Seena, Kilday Patrick S, Slezak Jeff M, Abdelsayed George A, Harrison Teresa N, Jacobsen Steven J, Chien Gary W
Urologist at the Los Angeles Medical Center in CA.
Research Manager in Biostatistics for the Southern California Permanente Medical Group in Pasadena.
Perm J. 2017;21:16-138. doi: 10.7812/TPP/16-138.
The association between cigarette smoking and erectile dysfunction has been well established. Studies demonstrate improvements in erectile rigidity and tumescence as a result of smoking cessation. Radical prostatectomy is also associated with worsening of erectile function secondary to damage to the neurovascular bundles. To our knowledge, no previous studies have examined the relationship between smoking cessation after prostate cancer diagnosis and its effect on sexual function following robotic prostatectomy. We sought to demonstrate the utility of a smoking cessation program among patients with prostate cancer who planned to undergo robotic prostatectomy at Kaiser Permanente Southern California.
All patients who underwent robotic prostatectomy between March 2011 and April 2013 with known smoking status were included, and were followed-up through November 2014. All smokers were offered the smoking cessation program, which included wellness coaching, tobacco cessation classes, and pharmacotherapy. Patients completed the Expanded Prostate Cancer Index Composite-26 (EPIC-26) health-related quality-of-life (HR-QOL) survey at baseline and postoperatively at 1, 3, 6, 12, 18, and 24 months. There were 2 groups based on smoking status: Continued smoking vs quitting group. Patient's age, Charlson Comorbidity Score, body mass index, educational level, median household income, family history of prostate cancer, race/ethnicity, language, nerve-sparing status, and preoperative/postoperative clinicopathology and EPIC-26 HR-QOL scores were examined. A linear regression model was used to predict sexual function recovery.
A total of 139 patients identified as smokers underwent the smoking cessation program and completed the EPIC-26 surveys. Fifty-six patients quit smoking, whereas 83 remained smokers at last follow-up. All demographics and clinicopathology were matched between the 2 cohorts. Smoking cessation, along with bilateral nerve-sparing status, were the only 2 modifiable factors associated with improved sexual function after prostatectomy (6.57 points, p = 0.0226 and 8.97 points, p = 0.0485, respectively).
In the setting of robotic prostatectomy, perioperative smoking cessation is associated with a significant improvement in long-term sexual functional outcome when other factors are adjusted.
吸烟与勃起功能障碍之间的关联已得到充分证实。研究表明戒烟可改善勃起硬度和肿胀程度。根治性前列腺切除术也会因神经血管束受损而导致勃起功能恶化。据我们所知，此前尚无研究探讨前列腺癌诊断后戒烟与其对机器人辅助前列腺切除术后性功能的影响之间的关系。我们试图证明戒烟计划在计划于南加州凯撒医疗中心接受机器人辅助前列腺切除术的前列腺癌患者中的效用。
纳入2011年3月至2013年4月期间接受机器人辅助前列腺切除术且已知吸烟状况的所有患者，并随访至2014年11月。所有吸烟者均被提供戒烟计划，该计划包括健康指导、戒烟课程和药物治疗。患者在基线时以及术后1、3、6、12、18和24个月完成扩展前列腺癌指数综合-26（EPIC-26）健康相关生活质量（HR-QOL）调查。根据吸烟状况分为两组：持续吸烟组与戒烟组。检查患者的年龄、查尔森合并症评分、体重指数、教育水平、家庭收入中位数、前列腺癌家族史、种族/民族、语言、保留神经状况以及术前/术后临床病理和EPIC-26 HR-QOL评分。使用线性回归模型预测性功能恢复情况。
共有139名被确定为吸烟者的患者接受了戒烟计划并完成了EPIC-26调查。56名患者戒烟，而83名患者在最后一次随访时仍为吸烟者。两个队列的所有人口统计学和临床病理特征均相匹配。戒烟以及双侧保留神经状况是前列腺切除术后与性功能改善相关的仅有的两个可改变因素（分别为6.57分，p = 0.0226和8.97分，p = 0.0485）。
在机器人辅助前列腺切除术的情况下，调整其他因素后，围手术期戒烟与长期性功能结局的显著改善相关。
