Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
Surg Endosc. 2021 Jul;35(7):3320-3328. doi: 10.1007/s00464-020-07770-7. Epub 2020 Jul 27.
Sarcopenia, a syndrome characterized by the loss of skeletal muscle mass, has attracted attention in the field of oncology, as it reflects poor nutritional status. The present study aimed to determine the risk factors for postoperative inguinal hernia (PIH) development after robot-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer, and discuss whether sarcopenia could be used as a sensitive predictor of PIH.
We reviewed the medical records of 147 patients who underwent RARP at our institution. The psoas muscle volume (PMV), as an indicator of sarcopenia, was quantified from computed tomography images using a 3-dimensional image analysis system. Multivariate cox regression analyses were performed to identify independent predictors of PIH, including pre- and peri-operative factors.
The mean PMV was 393 cm, and the correlation coefficient between PMV and body mass index was 0.37 (p < 0.01). The PIH-free rate at 2 years postoperatively was 78.2% among all patients. The multivariate analysis revealed that a PMV < 350 cm was a significant risk factor for PIH (p = 0.03; hazard ratio 2.19). Body mass index, age, prostate volume, lymph node dissection, nerve sparing, rectus muscle thickness, and console time were not related to PIH development. The PIH-free rate at 2 years postoperatively was 83.4% and 68.9% in patients with a PMV ≥ 350 cm and < 350 cm, respectively (p < 0.05).
PIH occurred significantly more frequently in patients with a PMV < 350 cm than in patients with a PMV ≥ 350 cm, and a low PMV was an independent risk factor for PIH. Thus, urologists should pay attention to the cumulative incidence of IH after RARP, especially in patients with a PMV < 350 cm.
肌肉减少症是一种以骨骼肌质量损失为特征的综合征，在肿瘤学领域引起了关注，因为它反映了不良的营养状况。本研究旨在确定前列腺癌患者机器人辅助腹腔镜根治性前列腺切除术后（RARP）发生腹股沟疝（PIH）的危险因素，并探讨是否可以将肌肉减少症用作 PIH 的敏感预测指标。
我们回顾了在我们机构接受 RARP 治疗的 147 名患者的病历。使用三维图像分析系统从 CT 图像中量化了腰大肌体积（PMV），作为肌肉减少症的指标。进行了多变量 Cox 回归分析，以确定 PIH 的独立预测因素，包括术前和围手术期因素。
平均 PMV 为 393cm，PMV 与体重指数之间的相关系数为 0.37（p<0.01）。所有患者术后 2 年的 PIH 无复发率为 78.2%。多变量分析显示，PMV<350cm 是 PIH 的显著危险因素（p=0.03；风险比 2.19）。体重指数、年龄、前列腺体积、淋巴结清扫、神经保留、直肌厚度和控制台时间与 PIH 发展无关。PMV≥350cm 和 PMV<350cm 的患者术后 2 年的 PIH 无复发率分别为 83.4%和 68.9%（p<0.05）。
PMV<350cm 的患者 PIH 发生率明显高于 PMV≥350cm 的患者，低 PMV 是 PIH 的独立危险因素。因此，泌尿科医生应注意 RARP 后 IH 的累积发生率，特别是 PMV<350cm 的患者。
