Banapour Pooya, Elliott Peter, Jabaji Ramzi, Parekh Ashish, Pathak Apurba, Merchant Madhur, Tamaddon Kirk
Department of Urology, Kaiser Los Angeles Medical Center, Los Angeles, USA.
Department of Urology, Kaiser West Los Angeles Hospital, Los Angeles, USA.
J Robot Surg. 2019 Apr;13(2):261-265. doi: 10.1007/s11701-018-0848-8. Epub 2018 Jul 13.
Since its inception, robot-assisted radical prostatectomy (RARP) has developed into a familiar surgical modality with improved perioperative outcomes including decreased hospital stay for localized prostate cancer patients. Experience with outpatient RARP has been reported as early as 2010. In this study, we evaluate the safety and feasibility of outpatient RARP by comparing perioperative outcomes between patients undergoing outpatient RARP to patients discharged on the day following surgery. This is a single-institution retrospective cohort study. Patients with localized disease who underwent RARP without pelvic lymph node dissection from September 2017 to January 2018 were included. T tests and Chi-squared analysis were used to compare demographic and perioperative characteristics of patients who were discharged on the same day of surgery (outpatient RARP) to patients discharged on the day after surgery (inpatient RARP). Of the 51 patients included in the study, 26 underwent outpatient RARP while 25 underwent inpatient RARP. There was no significant difference in mean age (61.4 vs 65.8 years, p = 0.05), BMI (27.1 vs 28.3 kg/m, p = 0.35), ethnicity, tobacco use (8 vs 15%, p = 0.41), PSA (8.7 vs 8.4 ng/dL, p = 0.77), biopsy Gleason score distribution, prostate size (51.8 vs 57.7 cc, p = 0.26) or preoperative hemoglobin (14.3 vs 13.4 g/dL, p = 0.06), respectively. There was no significant difference between operative time (95.3 vs 101 min, p = 0.16), EBL (52.8 vs 66.5 cc, p = 0.08), postoperative change in hemoglobin (- 1 vs - 1.1 g/dL, p = 0.62), pathologic stage distribution or complication rate (4 vs 8%, p = 0.58) between patients who underwent outpatient vs inpatient RARP, respectively. Outpatient RARP offers similar or improved perioperative outcomes when compared to inpatient RARP. We advocate outpatient RARP as a safe and feasible alternative to inpatient RARP for appropriately selected prostate cancer patients. Furthermore, we introduce an outpatient model that can be applied to other institutions seeking to implement outpatient RARP.
自开展以来，机器人辅助根治性前列腺切除术（RARP）已发展成为一种广为人知的手术方式，围手术期结局得到改善，包括局部前列腺癌患者的住院时间缩短。早在2010年就有门诊RARP的经验报道。在本研究中，我们通过比较门诊RARP患者与术后当天出院患者的围手术期结局，评估门诊RARP的安全性和可行性。这是一项单机构回顾性队列研究。纳入了2017年9月至2018年1月期间接受RARP且未行盆腔淋巴结清扫的局限性疾病患者。采用t检验和卡方分析比较手术当天出院患者（门诊RARP）与术后次日出院患者（住院RARP）的人口统计学和围手术期特征。在纳入研究的51例患者中，26例行门诊RARP，25例行住院RARP。平均年龄（61.4岁对65.8岁，p = 0.05）、BMI（27.1对28.3kg/m，p = 0.35）、种族、吸烟情况（8%对15%，p = 0.41）、PSA（8.7对8.4ng/dL，p = 0.77）、活检Gleason评分分布、前列腺大小（51.8对57.7cc，p = 0.26）或术前血红蛋白（14.3对13.4g/dL，p = 0.06）之间均无显著差异。门诊RARP与住院RARP患者的手术时间（95.3对101分钟，p = 0.16）、估计失血量（EBL，52.8对66.5cc，p = 0.08）、术后血红蛋白变化（-1对-1.1g/dL，p = 0.62）、病理分期分布或并发症发生率（4%对8%，p = 0.58）之间均无显著差异。与住院RARP相比，门诊RARP的围手术期结局相似或有所改善。我们主张对于适当选择的前列腺癌患者，门诊RARP是住院RARP的一种安全可行的替代方案。此外，我们介绍了一种可应用于其他寻求实施门诊RARP的机构的门诊模式。
