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单孔腹膜外和经腹膜根治性前列腺切除术:一项多机构倾向评分匹配研究。

Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched Study.

作者信息

Abou Zeinab Mahmoud, Beksac Alp Tuna, Ferguson Ethan, Kaviani Aaron, Moschovas Marcio Covas, Joseph Jean, Kim Moses, Crivellaro Simone, Nix Jeffrey, Patel Vipul, Kaouk Jihad

机构信息

Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.

Global Robotics Institude, Celebration, FL.

出版信息

Urology. 2023 Jan;171:140-145. doi: 10.1016/j.urology.2022.10.001. Epub 2022 Oct 13.

Abstract

OBJECTIVE

To compare the perioperative and early postoperative outcomes between single-port (SP) extraperitoneal radical prostatectomy (EPRP) and SP transperitoneal radical prostatectomy (TPRP), in a multi-institutional setting.

METHODS

We identified all patients who underwent SP robot-assisted radical prostatectomy at 6 different institutes. Data of 650 patients were collected and divided into 2 groups based on the surgical approach: SP EPRP or SP TPRP. A Propensity-score matched-pair analysis for body mass index (BMI), prostate size, and National Comprehensive Cancer Network risk was performed with a 1:1 ratio. Analysis of perioperative and postoperative outcomes was performed using Wilcoxon signed-rank test and chi-square and Fisher's exact tests.

RESULTS

After matching, 238 patients were included in each arm. The median follow-up period was 7 and 6 months for EPRP and TPRP groups, respectively. The total operative time was longer in the EPRP group (206 vs 155 minutes, P < .001). The EPRP group had a shorter length of hospitalization and same-day discharge rate compared to the TPRP approach (P < .001). There was no difference in the overall intraoperative or postoperative complications rate between the 2 groups, nor positive surgical margin rates.

CONCLUSION

The SP extraperitoneal approach is associated with a shorter hospital stay and higher rate of same-day discharge, with no difference in the surgical margin, or complication rates.

摘要

目的

在多机构环境中比较单孔(SP)腹膜外根治性前列腺切除术(EPRP)和SP经腹根治性前列腺切除术(TPRP)的围手术期及术后早期结局。

方法

我们确定了在6家不同机构接受SP机器人辅助根治性前列腺切除术的所有患者。收集了650例患者的数据,并根据手术方式分为2组:SP EPRP或SP TPRP。对体重指数(BMI)、前列腺大小和美国国立综合癌症网络风险进行倾向评分匹配对分析,比例为1:1。使用Wilcoxon符号秩检验、卡方检验和Fisher精确检验对围手术期和术后结局进行分析。

结果

匹配后,每组纳入238例患者。EPRP组和TPRP组的中位随访期分别为7个月和6个月。EPRP组的总手术时间更长(206分钟对155分钟,P <.001)。与TPRP手术方式相比,EPRP组的住院时间更短,当日出院率更高(P <.001)。两组的总体术中或术后并发症发生率以及切缘阳性率均无差异。

结论

SP腹膜外手术方式与较短的住院时间和较高的当日出院率相关,切缘或并发症发生率无差异。

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