School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, VIC, 3004, Australia.
Radiation Oncology, Alfred Health, South Block Ground, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
BMC Urol. 2022 Feb 7;22(1):18. doi: 10.1186/s12894-022-00966-0.
Robot-assisted radical prostatectomy (RARP) rates have been increasing worldwide despite a lack of evidence of superior patient-reported outcomes (PROs) compared to open radical prostatectomy (ORP).
This retrospective study included men who contributed data to the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic), underwent ORP or RARP between January 2014 and May 2018, and completed the EPIC-26 questionnaire 12 months post-surgery. Urinary and sexual bother items, the urinary incontinence domain score, the urinary irritative/obstructive domain score, the sexual domain score and the pad usage item from the EPIC-26 questionnaire were compared between the two cohorts. Unmatched and propensity score matched cohorts were used to determine if there were differences in urinary and sexual PROs between ORP and RARP after accounting for the patient case-mix and surgeon characteristics.
Of 3826 patients undergoing radical prostatectomy (RP), 1047 received ORP and 2779 received RARP. Propensity score matching reduced the magnitude of the observed differences in four out of six outcomes (urinary bother, urinary incontinence domain, pad usage and sexual domain). Using a propensity score matched cohort, there were no statistically significant differences for RARP patients, compared to ORP patients, in terms of urinary bother (Rd = 0.47%, P = 0.707), urinary incontinence domain scores (Coeff = - 0.84, P = 0.506), urinary irritative/obstructive domain scores (Coeff = 1.03, P = 0.105), pad usage (Rd = - 0.75%, P = 0.771) and sexual bother (Rd = - 0.89%, P = 0.731). RARP patients had slightly higher sexual domain scores (Coeff = 3.65, P = 0.005).
There were no differences in urinary PROs between ORP and RARP when assessed 12 months post-surgery. The sexual domain slightly favoured RARP, however this was not deemed clinically significant.
尽管机器人辅助根治性前列腺切除术 (RARP) 的患者报告结局 (PROs) 与开放式根治性前列腺切除术 (ORP) 相比并无优势，但全球范围内 RARP 的使用率仍在不断增加。
本回顾性研究纳入了 2014 年 1 月至 2018 年 5 月期间在前列腺癌结局登记-维多利亚州 (PCOR-Vic) 登记处登记并接受 ORP 或 RARP 治疗且术后 12 个月完成 EPIC-26 问卷的男性。比较了这两个队列的 EPIC-26 问卷中的尿失禁和性功能障碍相关项目、尿失禁域评分、排尿刺激/梗阻域评分、性功能域评分和尿垫使用情况。采用未匹配和倾向评分匹配队列来确定在考虑患者病例组合和外科医生特征后，ORP 和 RARP 之间在尿失禁和性功能 PRO 方面是否存在差异。
在 3826 例接受根治性前列腺切除术 (RP) 的患者中，1047 例接受 ORP，2779 例接受 RARP。倾向评分匹配后，在六个结局中的四个结局中，观察到的差异幅度有所减小（排尿困扰、尿失禁域、尿垫使用和性功能域）。使用倾向评分匹配队列，与 ORP 患者相比，RARP 患者在排尿困扰（差异率 [Rd] = 0.47%，P = 0.707）、尿失禁域评分（系数 [Coeff] = -0.84，P = 0.506）、排尿刺激/梗阻域评分（Coeff = 1.03，P = 0.105）、尿垫使用（Rd = -0.75%，P = 0.771）和性功能困扰（Rd = -0.89%，P = 0.731）方面差异无统计学意义。RARP 患者的性功能域评分略高（Coeff = 3.65，P = 0.005）。
在术后 12 个月时，ORP 和 RARP 患者的尿失禁 PRO 无差异。在性功能方面，RARP 略占优势，但这并不具有临床意义。
