Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute; Department of Urology, HYGEIA Hospital, Athens, Greece.
Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg.
Urol Oncol. 2020 Jan;38(1):5.e1-5.e8. doi: 10.1016/j.urolonc.2019.07.015. Epub 2019 Aug 21.
Differences exist concerning when and how to perform lymph node dissection (LND) during radical prostatectomy due to lack of high-grade evidence to its safety and efficacy. We aimed to compare readmission rates between limited and extended LND during open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP).
We conducted a prospective trial of 3,706 eligible patients comparing ORP vs. RARP (LAPPRO). Six hundred and twenty-seven underwent concomitant LND. Data were retrieved for readmissions within 90 days from surgery from the Swedish Patient Registry. Causes for readmissions were classified according to the modified Clavien-Dindo classification system. We estimated risks for readmission stratified by type of LND and surgical approach.
We recorded 107 readmissions in 90 patients. The overall readmission rate was 14% (90/627). In the open group, extended LND had a higher, but not statistically significant readmission rate of 18% compared to 11% after limited LND (95%CI 0.87-3.01). In the robot-assisted group, readmissions after extended LND did not differ from limited LND (15% vs. 18%, 95%CI 0.49-1.61). RARP with limited LND showed a higher risk for any (RR 1.98, 95%CI [1.02-3.81]) as well as Clavien-Dindo grade 1 to 2 readmissions (RR 2.49, 95%CI [1.10-5.63]) compared to open approach with limited LND. Robot-assisted extended LND reduced the risk for Clavien-Dindo grade 3 to 5 complications leading to readmissions compared to the open approach by 59% (RR 0.41, 95%CI [0.19-0.87]).
The risk for hospital readmission was similar when performing limited or extended LND during a radical prostatectomy. Robot-assisted technique for performing extended LND may decrease the risk for severe complications.
由于缺乏关于淋巴结清扫术（LND）安全性和有效性的高级别证据，因此在根治性前列腺切除术时，何时以及如何进行 LND 存在差异。我们旨在比较开放式根治性前列腺切除术（ORP）和机器人辅助根治性前列腺切除术（RARP）中局限性和广泛性 LND 的再入院率。
我们对 3706 名符合条件的患者进行了前瞻性试验，比较了 ORP 与 RARP（LAPPRO）。627 例患者同时接受了 LND。从瑞典患者登记处检索了手术后 90 天内的再入院数据。根据改良的 Clavien-Dindo 分类系统对再入院的原因进行分类。我们根据 LND 类型和手术方法分层估计了再入院的风险。
我们记录了 90 名患者中的 107 例再入院。总体再入院率为 14%（90/627）。在开放性组中，广泛 LND 的再入院率较高，但无统计学意义，为 18%，而局限性 LND 为 11%（95%CI 0.87-3.01）。在机器人辅助组中，广泛 LND 后的再入院率与局限性 LND 无差异（15%与 18%，95%CI 0.49-1.61）。与开放性局限性 LND 相比，RARP 局限性 LND 的任何（RR 1.98，95%CI [1.02-3.81]）以及 Clavien-Dindo 1-2 级再入院（RR 2.49，95%CI [1.10-5.63]）的风险更高。与开放性手术相比，机器人辅助广泛 LND 可将导致再入院的 Clavien-Dindo 3-5 级并发症的风险降低 59%（RR 0.41，95%CI [0.19-0.87]）。
在根治性前列腺切除术时行局限性或广泛性 LND 的再入院风险相似。机器人辅助技术行广泛 LND 可能降低严重并发症的风险。
