Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany; Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
Clin Genitourin Cancer. 2019 Oct;17(5):e939-e945. doi: 10.1016/j.clgc.2019.05.022. Epub 2019 May 27.
Cytoreductive radical prostatectomy (CRP) may offer a survival advantage, according to several retrospective analyses. However, no direct comparisons are available regarding the type of surgical approach (open vs. robotic) in the metastatic setting. To address intraoperative and postoperative complications of robotically assisted CRP relative to open CRP in patients with metastatic prostate cancer.
Within the National Inpatient Sample database (2008-2013), we identified patients with metastatic prostate cancer who underwent robotically assisted versus open CRP. Multivariable logistic regression, multivariable Poisson regression models, and linear regression models were used.
Of 874 patients who underwent CRP, 412 (47.1%) versus 462 (52.9%) underwent open versus robotically assisted CRP, respectively. Between 2008 and 2013, robotically assisted CRP rates increased from 7.6% to 50.0% (P = .5). In multivariable logistic regression models, robotically assisted CRP resulted in lower rates of overall (odds ratio [OR], 0.42; P < .001), miscellaneous medical (OR, 0.47; P = .02), and miscellaneous surgical complications (OR, 0.40; P = .04), as well as in lower rates of blood transfusions (OR, 0.19; P < .001). In multivariable Poisson regression models, robotically assisted CRP was associated with shorter stay (OR, 0.72; P < .001) and higher total hospital charges ($2483 more for each robotic surgery; P < .001). Similar results were recorded after adjustment for clustering.
The intraoperative and postoperative complications associated with robotically assisted CRP are lower than those of open CRP. Similarly, robotically assisted CRP is associated with shorter stay. Conversely, an increase in total hospital charges is associated with robotically assisted CRP. Nonetheless, the complication profile of robotically assisted CRP validates its safety and feasibility.
几项回顾性分析表明，细胞减灭性根治性前列腺切除术（CRP）可能具有生存优势。然而，在转移性环境中，关于手术方法（开放与机器人辅助）的直接比较尚不可用。本研究旨在比较机器人辅助 CRP 与开放性 CRP 治疗转移性前列腺癌患者的术中及术后并发症。
在国家住院患者样本数据库（2008-2013 年）中，我们确定了接受机器人辅助与开放性 CRP 治疗的转移性前列腺癌患者。采用多变量逻辑回归、多变量泊松回归模型和线性回归模型。
在 874 例接受 CRP 治疗的患者中，412 例（47.1%）接受开放性 CRP 治疗，462 例（52.9%）接受机器人辅助 CRP 治疗。2008 年至 2013 年期间，机器人辅助 CRP 治疗率从 7.6%增加至 50.0%（P=0.5）。在多变量逻辑回归模型中，机器人辅助 CRP 导致总体并发症（优势比 [OR]，0.42；P<0.001）、其他医学并发症（OR，0.47；P=0.02）和其他手术并发症（OR，0.40；P=0.04）的发生率较低，输血率（OR，0.19；P<0.001）也较低。在多变量泊松回归模型中，机器人辅助 CRP 与较短的住院时间（OR，0.72；P<0.001）和更高的总住院费用（每例机器人手术增加 2483 美元；P<0.001）相关。调整聚类后也得到了类似的结果。
机器人辅助 CRP 相关的术中及术后并发症低于开放性 CRP。同样，机器人辅助 CRP 与较短的住院时间相关。相反，机器人辅助 CRP 与总住院费用的增加相关。尽管如此，机器人辅助 CRP 的并发症谱验证了其安全性和可行性。
