Wallerstedt Lantz Anna, Stranne Johan, Tyritzis Stavros I, Bock David, Wallin David, Nilsson Hanna, Carlsson Stefan, Thorsteinsdottir Thordis, Gustafsson Ove, Hugosson Jonas, Bjartell Anders, Wiklund Peter, Steineck Gunnar, Haglind Eva
a Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet, Stockholm , Solna , Sweden.
b Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.
Scand J Urol. 2019 Feb;53(1):26-33. doi: 10.1080/21681805.2018.1556729. Epub 2019 Feb 6.
All types of surgery are associated with complications. The debate is ongoing whether robot-assisted radical prostatectomy can lower this risk compared to open surgery. The objective of the present study was to evaluate post-operative adverse events leading to readmissions, using clinical records to classify these adverse events systematically. A prospective controlled trial of men who underwent robot-assisted laparoscopic (RALP) or retropubic radical prostatectomy (RRP) at 14 departments of Urology (LAPPRO) between 2008 and 2011. Data on all readmissions within 3 months of surgery were collected from the Patient registry, Swedish Board of Health and Welfare. For each readmission the highest Clavien-Dindo grade was listed. A total of 4003 patients were included in the LAPPRO trial and, after applying exclusion criteria, 3706 patients remained for analyses. The results showed no statistically significant difference in the overall readmission rates (8.1 vs. 7.1%) or readmission due to major complications (Clavien-Dindo ≥3b, 1.7 vs. 1.9%) between RALP and RRP within 90 days after surgery. Patients subjected to lymph-node dissection (LND) had twice the risk for readmission as men not undergoing LND, irrespective RALP or RRP technique. Blood transfusion was significantly more frequent during and within 30 days of RRP surgery (16 vs. 4%). Abdominal symptoms were more common after RALP. There is a substantial risk for hospital readmission after prostate-cancer surgery, regardless of technique; although major complications are rare. Regardless of surgical technique, attention should be focused on specific types of complications.
所有类型的手术都伴有并发症。机器人辅助根治性前列腺切除术与开放手术相比是否能降低这种风险的争论仍在继续。本研究的目的是评估导致再次入院的术后不良事件，并利用临床记录对这些不良事件进行系统分类。这是一项前瞻性对照试验，研究对象为2008年至2011年期间在14个泌尿外科科室接受机器人辅助腹腔镜根治性前列腺切除术（RALP）或耻骨后根治性前列腺切除术（RRP）的男性患者。从瑞典卫生和福利委员会的患者登记处收集了手术3个月内所有再次入院的数据。对于每次再次入院，列出最高的Clavien-Dindo分级。LAPPRO试验共纳入4003例患者，应用排除标准后，剩余3706例患者进行分析。结果显示，术后90天内，RALP组和RRP组的总体再次入院率（8.1%对7.1%）或因严重并发症导致的再次入院率（Clavien-Dindo≥3b，1.7%对1.9%）无统计学显著差异。无论采用RALP还是RRP技术，接受淋巴结清扫（LND）的患者再次入院风险是未接受LND患者的两倍。RRP手术期间及术后30天内输血明显更频繁（16%对4%）。RALP术后腹部症状更常见。前列腺癌手术后再次入院的风险很大，无论采用何种技术；尽管严重并发症很少见。无论手术技术如何，都应关注特定类型的并发症。
