Wenzel Mike, Preisser Felix, Theissen Lena H, Humke Clara, Welte Maria N, Wittler Clarissa, Kluth Luis A, Karakiewicz Pierre I, Chun Felix K H, Mandel Philipp, Becker Andreas
Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Front Surg. 2020 Nov 10;7:584897. doi: 10.3389/fsurg.2020.584897. eCollection 2020.
To analyze the effect of adverse preoperative patient and tumor characteristics on perioperative outcomes of open (ORP) and robot-assisted radical prostatectomy (RARP). We retrospectively analyzed 656 patients who underwent ORP or RARP according to intraoperative blood loss (BL), operation time (OR time), neurovascular bundle preservation (NVBP) and positive surgical margins (PSM). Univariable and multivariable logistic regression models were used to identify risk factors for impaired perioperative outcomes. Of all included 619 patients, median age was 66 years. BMI (<25 vs. 25-30 vs. ≥30) had no influence on blood loss. Prostate size >40cc recorded increased BL compared to prostate size ≤ 40cc in patients undergoing ORP (800 vs. 1200 ml, < 0.001), but not in patients undergoing RARP (300 vs. 300 ml, = 0.2). Similarly, longer OR time was observed for ORP in prostates >40cc, but not for RARP. Overweight (BMI 25-30) and obese ORP patients (BMI ≥30) showed longer OR time compared to normal weight (BMI <25). Only obese patients, who underwent RARP showed longer OR time compared to normal weight. NVBP was less frequent in obese patients, who underwent ORP, relative to normal weight (25.8% vs. 14.0%, < 0.01). BMI did not affect NVPB at RARP. No differences in PSM were recorded according to prostate volume or BMI in ORP or RARP. In multivariable analyses, patient characteristics such as prostate volume and BMI was an independent predictor for prolonged OR time. Moreover, tumor characteristics (stage and grade) predicted worse perioperative outcome. Patients with larger prostates and obese patients undergoing ORP are at risk of higher BL, OR time or non-nervesparing procedure. Conversely, in patients undergoing RARP only obesity is associated with increased OR time. Patients with larger prostates or increased BMI might benefit most from RARP compared to ORP.
分析术前患者不良特征和肿瘤特征对开放性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）围手术期结局的影响。我们回顾性分析了656例行ORP或RARP的患者，依据术中失血（BL）、手术时间（OR时间）、神经血管束保留（NVBP）及手术切缘阳性（PSM）情况进行分析。采用单变量和多变量逻辑回归模型来确定围手术期结局受损的危险因素。在所有纳入的619例患者中，中位年龄为66岁。体重指数（<25 vs. 25 - 30 vs.≥30）对失血无影响。在接受ORP的患者中，前列腺体积>40cc者的失血量相较于前列腺体积≤40cc者增加（800 vs. 1200 ml，<0.001），但在接受RARP的患者中并非如此（300 vs. 300 ml，=0.2）。同样，前列腺体积>40cc的患者行ORP时手术时间更长，但RARP并非如此。超重（体重指数25 - 30）和肥胖的ORP患者相较于正常体重（体重指数<25）患者手术时间更长。仅接受RARP的肥胖患者相较于正常体重患者手术时间更长。接受ORP的肥胖患者中NVBP的发生率低于正常体重患者（25.8% vs. 14.0%，<0.01）。体重指数对RARP的NVBP无影响。在ORP或RARP中，根据前列腺体积或体重指数未记录到PSM的差异。在多变量分析中，前列腺体积和体重指数等患者特征是手术时间延长的独立预测因素。此外，肿瘤特征（分期和分级）预示着更差的围手术期结局。前列腺较大的患者和接受ORP的肥胖患者有更高失血、更长手术时间或非保留神经手术的风险。相反，在接受RARP的患者中，仅肥胖与手术时间延长相关。相较于ORP，前列腺较大或体重指数增加的患者可能从RARP中获益最多。
