高体重指数、侵袭性肿瘤和长柄时间是机器人辅助根治性前列腺切除术和盆腔淋巴结清扫术后症状性淋巴囊肿形成的独立预测因素。
High BMI, Aggressive Tumours and Long Console Time Are Independent Predictive Factors for Symptomatic Lymphocele Formation after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection.
机构信息
Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany.
出版信息
Urol Int. 2021;105(5-6):453-459. doi: 10.1159/000514439. Epub 2021 Apr 1.
INTRODUCTION
Lymphocele (LC) formation is a common complication which may cause severe symptoms after robot-assisted radical prostatovesiculectomy (RARP) with concomitant pelvic lymph node dissection (PLND). Compared to open radical prostatectomy, the amount of data on potential risk factors for LC formation is still limited. The aim of the present study was to identify risk factors for symptomatic LC formation (sLC) after RARP with PLND.
METHODS
We used the data of a prospective multicentre series of 232 RARP patients which were treated between March 2017 and December 2017. The primary endpoint was the presence of sLC within 90 days. Asymptomatic LC (aLC) formation was also recorded. We evaluated clinical, perioperative, and histopathological criteria and compared their distribution in patients with and without post-operative sLC. Uni- and multivariable logistic regression analyses (MVAs) were performed to identify potential predictors for LC formation. Regarding the influence of patients' BMI, 2 models were calculated: BMI continuously (model 1) and BMI dichotomized with cut-off 30 kg/m2 (WHO definition, model 2).
RESULTS
Post-operative sLC was present in 21 patients (9.1%), while aLC was detected in 49 patients (21.1%) 90 days after RARP with PLND. Patients with sLC showed higher median baseline PSA levels (9.8 vs. 8.1 ng/mL), higher prevalence of obesity (BMI >30; 42.9 vs. 19.9%), and longer median console time (180 vs. 165 min) compared to patients without sLC. On MVA higher BMI {model 1: OR 1.145 (confidence interval [CI] 1.025-1.278); model 2: OR 2.761 (1.045-7.296)}, longer console time (model 1: OR 1.013 [1.005-1.021]; model 2: OR 1.013 [1.005-1.020]) and an ISUP grade ≥3 (model 1: OR 3.247 [1.182-8.917]; model 2: OR 2.791 [1.050-7.423]) were identified as independent predictors for sLC development.
CONCLUSION
Patients with aggressive tumours and higher BMI should be informed about a potentially increased risk for sLC formation. In case of a long console time, a close and regular follow-up should be considered to check for LC development.
简介
淋巴囊肿（LC）的形成是一种常见的并发症，在机器人辅助根治性前列腺切除术（RARP）联合盆腔淋巴结清扫术（PLND）后可能导致严重症状。与开放性根治性前列腺切除术相比，关于 LC 形成的潜在危险因素的数据仍然有限。本研究的目的是确定 RARP 联合 PLND 后发生症状性 LC（sLC）的危险因素。
方法
我们使用了 2017 年 3 月至 2017 年 12 月期间进行的一项前瞻性多中心 232 例 RARP 患者的队列数据。主要终点是术后 90 天内存在 sLC。还记录了无症状性 LC（aLC）的形成。我们评估了临床、围手术期和组织病理学标准，并比较了术后发生 sLC 和未发生 sLC 的患者的分布情况。进行了单变量和多变量逻辑回归分析（MVAs），以确定 LC 形成的潜在预测因素。关于患者 BMI 的影响，我们计算了 2 个模型：BMI 连续（模型 1）和 BMI 二分法（以 30kg/m2 为界，WHO 定义，模型 2）。
结果
术后 sLC 发生在 21 例患者（9.1%）中，而在 RARP 联合 PLND 后 90 天，49 例患者（21.1%）检测到 aLC。与无 sLC 的患者相比，sLC 患者的中位基线 PSA 水平更高（9.8 vs. 8.1ng/mL），肥胖（BMI >30）的患病率更高（42.9% vs. 19.9%），控制台时间更长（180 分钟 vs. 165 分钟）。在 MVA 中，更高的 BMI（模型 1：OR 1.145（置信区间 [CI] 1.025-1.278）；模型 2：OR 2.761（1.045-7.296）），更长的控制台时间（模型 1：OR 1.013[1.005-1.021]；模型 2：OR 1.013[1.005-1.020]）和 ISUP 分级≥3（模型 1：OR 3.247[1.182-8.917]；模型 2：OR 2.791[1.050-7.423]）被确定为 sLC 发展的独立预测因素。
结论
具有侵袭性肿瘤和较高 BMI 的患者应被告知潜在的 sLC 形成风险增加。如果控制台时间较长，应考虑进行密切和定期随访，以检查 LC 的发展。
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