根治性前列腺切除术后吻合口狭窄的可靠危险因素能否确定？

Can we define reliable risk factors for anastomotic strictures following radical prostatectomy?

机构信息

Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany.

Department of Urology, University Hospital Freiburg, Freiburg, Germany.

出版信息

Urologia. 2020 Nov;87(4):170-174. doi: 10.1177/0391560320933024. Epub 2020 Jun 27.

DOI:10.1177/0391560320933024

PMID:32594901

Abstract

BACKGROUND

To identify risk factors for anastomotic strictures in patients after radical prostatectomy.

METHODS

In all, 140 prostate cancer patients with one or more postoperative anastomotic strictures after radical prostatectomy were included. All patients underwent transurethral anastomotic resection at the University Hospital of Munich between January 2009 and May 2016. Clinical data and follow-up information were retrieved from patients' records. Statistical analysis was done using Kaplan-Meier curves and log rank-test with time to first transurethral anastomotic resection as endpoint, Chi-square-test, and Mann-Whitney-U test.

RESULTS

In all, 140 patients with a median age of 67 years (IQR: 61-71 years) underwent radical prostatectomy. Median age at time of transurethral anastomotic resection was 68 years (IQR: 62-72). Patients needed 2 surgical interventions in median (range: 1-15). Median time from radical prostatectomy to transurethral anastomotic resection was 6 months (IQR: 3.9-17.4). Median duration of catheterization after radical prostatectomy was 10 days (IQR: 8-13). In all, 26% (36/140) received additional radiotherapy. Regarding time to first transurethral anastomotic resection, age and longer duration of catheterization after radical prostatectomy with a cutoff of 7 days showed no statistically significant differences (p = 0.392 and p = 0.141, respectively). Tumor stage was no predictor for development of anastomotic strictures (p = 0.892), and neither was prior adjuvant radiation (p = 0.162). Potential risk factors were compared between patients with up to 2 strictures (low-risk) and patients developing > 2 strictures (high-risk): high-risk patients had more often injection of cortisone during surgery (14% vs 0%, p < 0.001) and more frequently advanced tumor stage pT > 2 (54% vs 38%, p = 0.055), respectively. Other risk factors did not show any significant difference compared to number of prior transurethral anastomotic strictures.

CONCLUSIONS

We could not identify a reliable risk factor to predict development of anastomotic strictures following radical prostatectomy.

摘要

背景

确定根治性前列腺切除术后吻合口狭窄患者的风险因素。

方法

共纳入 140 例根治性前列腺切除术后出现 1 个或多个吻合口狭窄的前列腺癌患者。所有患者于 2009 年 1 月至 2016 年 5 月在慕尼黑大学医院行经尿道吻合口切除术。从患者病历中检索临床资料和随访信息。使用 Kaplan-Meier 曲线和对数秩检验，以首次经尿道吻合口再手术时间为终点，进行统计学分析。使用卡方检验和曼-惠特尼 U 检验。

结果

共纳入 140 例患者，中位年龄为 67 岁（IQR：61-71 岁），接受根治性前列腺切除术。经尿道吻合口再手术的中位年龄为 68 岁（IQR：62-72）。患者平均接受 2 次手术干预（范围：1-15）。从根治性前列腺切除术到经尿道吻合口再手术的中位时间为 6 个月（IQR：3.9-17.4）。根治性前列腺切除术后平均导尿时间为 10 天（IQR：8-13）。共 26%（36/140）患者接受了额外的放疗。关于首次经尿道吻合口再手术时间，年龄和根治性前列腺切除术后导尿时间延长（截断值为 7 天）与统计学无显著差异（p=0.392 和 p=0.141）。肿瘤分期不是吻合口狭窄发展的预测因素（p=0.892），辅助放疗也不是（p=0.162）。将患者分为狭窄数量≤2 条（低危）和>2 条（高危）后，比较潜在的危险因素：高危患者术中注射皮质类固醇的比例更高（14% vs 0%，p<0.001），肿瘤分期更高（pT>2）的比例更高（54% vs 38%，p=0.055）。与经尿道吻合口再狭窄的数量相比，其他危险因素没有显示出任何显著差异。