Meguro Satoru, Haga Nobuhiro, Imai Hitomi, Yoshida Yuki, Takinami-Honda Ruriko, Matsuoka Kanako, Hoshi Seiji, Hata Junya, Sato Yuichi, Akaihata Hidenori, Kataoka Masao, Ogawa Soichiro, Kojima Yoshiyuki
Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan.
JSLS. 2021 Jan-Mar;25(1). doi: 10.4293/JSLS.2020.00078.
This study was conducted to identify whether surgical stress during the peri-operative period of robot-assisted radical prostatectomy might affect biochemical recurrence in patients with positive surgical margins.
Participants in the present study were 324 consecutive patients with localized prostate cancer who underwent robot-assisted radical prostatectomy between February 2013 and June 2018. Positive surgical margins were diagnosed in 61 of them. Patients with positive surgical margins were divided into those with (n = 19) and those without (n = 42) biochemical recurrence. Lymph node dissection, estimated blood loss, inhalation anesthetic volume, and surgical duration were evaluated as indicators of surgical stress. White blood cell count, C-reactive protein, body temperature, and usage of analgesics were postoperatively evaluated as surrogate markers of surgical stress. The associations between factors, including patients' characteristics and pathological features, and biochemical recurrence were investigated.
In univariate analyses, surgical duration ( = 0.004), D'Amico risk class ( = 0.002), Gleason score ( = 0.022) and the number of positive cores in prostate biopsy ( = 0.009) were statistically significantly associated with biochemical recurrence. In multivariate analyses, only surgical duration was significantly associated with biochemical recurrence ( = 0.042), at a cut-off value of surgical duration of 228.5 minutes.
Prolonged surgical duration is associated with biochemical recurrence in patients with positive surgical margins. Thus, surgical duration should be limited as much as possible to reduce surgical stress, which might cause biochemical recurrence.
本研究旨在确定机器人辅助根治性前列腺切除术围手术期的手术应激是否会影响手术切缘阳性患者的生化复发。
本研究的参与者为2013年2月至2018年6月期间连续接受机器人辅助根治性前列腺切除术的324例局限性前列腺癌患者。其中61例被诊断为手术切缘阳性。手术切缘阳性的患者被分为发生生化复发的患者（n = 19）和未发生生化复发的患者（n = 42）。评估淋巴结清扫、估计失血量、吸入麻醉剂用量和手术时长作为手术应激的指标。术后评估白细胞计数、C反应蛋白、体温和镇痛药的使用情况作为手术应激的替代标志物。研究包括患者特征和病理特征在内的因素与生化复发之间的关联。
在单因素分析中，手术时长（P = 0.004）、达米科风险分级（P = 0.002）、 Gleason评分（P = 0.022）和前列腺活检阳性核心数量（P = 0.009）与生化复发在统计学上显著相关。在多因素分析中，仅手术时长与生化复发显著相关（P = 0.042），手术时长的截断值为228.5分钟。
手术切缘阳性患者的生化复发与手术时长延长有关。因此，应尽可能限制手术时长以减轻可能导致生化复发的手术应激。
