Bukavina Laura, Mishra Kirtishri, Mahran Amr, Fernstrum Austin, Ray Al, Markt Sarah, Schumacher Fredrick, Conroy Britt, Abouassaly Robert, MacLennan Gregory, Smith Garrett, Ferry Elizabeth, Wong Daniel, Lotan Yair, Chaparala Hemant, Sharp David, Alazem Kareem, Moinzadeh Alireza, Adamic Brittany, Zagaja Gregory, Kang Puneet, Lawry Holly, Lee Benjamin, Calaway Adam, Ponsky Lee
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
Urol Oncol. 2021 Jun;39(6):365.e17-365.e23. doi: 10.1016/j.urolonc.2020.10.071. Epub 2020 Nov 5.
Multiple robotic-assisted surgeries are often performed within a single operating day; however, the impact of this practice on patient outcomes has not been examined. We aim to determine whether outcomes for robotic-assisted laparoscopic prostatectomy (RALP) differed when performed sequentially.
A multi-institutional, retrospective cohort study was conducted involving a total of 8 academic centers between years 2015 and 2018. Participants were adult males undergoing RALP for localized prostate cancer on operative days in which 2 RALP cases were performed sequentially by the same resident-attending team. The primary outcome of the study was presence of positive surgical margin (PSM). Secondary outcomes were lymph node yield, operative time, and estimated blood loss. The primary analysis was a random effects meta-analysis model for PSM.
Overall, 898 RALP cases (449 sequential pairs) were included in the study. There was no significant difference in PSM rate (27.2% vs. 30.3%, P= 0.338) between first and second case groups, respectively. Utilizing random effects meta-analysis, the second case cohort had no increased risk of PSM (OR 1.23, P= 0.40). Higher blood loss was noted in the second case cohort (186.7 ml vs. 221.7 ml, P = 0.002). Additionally, factors associated with PSM were increasing prostate specific antigen, higher percent tumor involvement, extraprostatic extension, and seminal vesicle invasion.
Case sequence was not associated with PSM, lymph node yield, or operative time for RALP. Disease specific factors and institutional experience are associated with increased risk for positive surgical margin which can aid providers in scheduling of patients.
多个机器人辅助手术通常在单个手术日进行；然而，这种做法对患者预后的影响尚未得到研究。我们旨在确定机器人辅助腹腔镜前列腺切除术（RALP）连续进行时的预后是否存在差异。
进行了一项多机构回顾性队列研究，涉及2015年至2018年期间的8个学术中心。参与者为成年男性，在同一住院医师-主治医生团队连续进行2例RALP手术的手术日接受局限性前列腺癌的RALP手术。该研究的主要结局是手术切缘阳性（PSM）的存在情况。次要结局包括淋巴结获取量、手术时间和估计失血量。主要分析是针对PSM的随机效应荟萃分析模型。
总体而言，该研究纳入了898例RALP手术病例（449对连续病例）。第一组和第二组病例的PSM率分别为27.2%和30.3%，差异无统计学意义（P = 0.338）。采用随机效应荟萃分析，第二组病例发生PSM的风险未增加（OR 1.23，P = 0.40）。第二组病例的失血量更高（186.7 ml对221.7 ml，P = 0.002）。此外，与PSM相关的因素包括前列腺特异性抗原升高、肿瘤累及百分比更高、前列腺外侵犯和精囊侵犯。
病例顺序与RALP的PSM、淋巴结获取量或手术时间无关。疾病特异性因素和机构经验与手术切缘阳性风险增加相关，这有助于医疗人员安排患者手术。
