Department of Urology, Ankara Bilkent City Hospital, Ankara-Türkiye.
Department of Urology, Sirnak State Hospital, Sirnak-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Jun;30(6):423-429. doi: 10.14744/tjtes.2024.36332.
Robot-Assisted Radical Prostatectomy (RARP) is increasingly becoming the standard surgical treatment for prostate cancer. While some risk factors for postoperative complications of RARP have been identified, no scoring model that incorporates both preoperative physical status of the patient and intraoperative risk factors has been developed. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score was initially described to predict postoperative complications after gastrointestinal surgical procedures. This study aims to assess the effectiveness of the E-PASS score in predicting postoperative complications of RARP.
A retrospective evaluation was conducted on 204 patients who underwent RARP between 2019 and 2022. Demographic data, parameters indicating patients' preoperative physical condition, and intraoperative risk factors were analyzed. The E-PASS score and subscores were calculated for each patient.
Of the patients, 164 (80.4%) were discharged without any postoperative complications (Group 1), and 40 (19.6%) experienced various degrees of complications (Group 2). Patients in Group 2 had higher rates of previous abdominal surgery, elevated Eastern Cooperative Oncology Group (ECOG) performance scores, longer surgical durations, and higher E-PASS scores. To assess the effectiveness of the Comprehensive Risk Score (CRS) as a predictive factor for postoperative complications, a receiver operating characteristic (ROC) curve was constructed with a 95% confidence interval (CI), and a cut-off value was established. The cut-off value for CRS was determined to be -0.0345 (area under the curve [AUC]=0.783, CI: 0.713-0.853; p<0.001). Patients with a CRS higher than the cut-off value had a 16.4 times higher rate of postoperative complications after RARP (95% CI: 5.58-48.5).
The E-PASS scoring model successfully predicts postoperative complications in patients undergoing RARP by using preoperative data about the physical status of the patient and surgical risk factors. The E-PASS score and its subscores could be utilized as objective criteria to determine the risk of postoperative complications before and immediately after surgery.
机器人辅助根治性前列腺切除术（RARP）日益成为前列腺癌的标准手术治疗方法。虽然已经确定了 RARP 术后并发症的一些危险因素，但尚未开发出一种同时包含患者术前身体状况和术中危险因素的评分模型。生理能力和手术应激估计（E-PASS）评分最初是为预测胃肠道手术后的术后并发症而描述的。本研究旨在评估 E-PASS 评分预测 RARP 术后并发症的有效性。
对 2019 年至 2022 年间接受 RARP 的 204 例患者进行回顾性评估。分析了患者的人口统计学数据、表示患者术前身体状况的参数以及术中危险因素。计算每位患者的 E-PASS 评分和子评分。
204 例患者中，164 例（80.4%）术后无任何并发症出院（第 1 组），40 例（19.6%）出现不同程度的并发症（第 2 组）。第 2 组患者既往腹部手术比例较高，东部合作肿瘤学组（ECOG）表现评分升高，手术时间较长，E-PASS 评分较高。为评估综合风险评分（CRS）作为术后并发症预测因素的有效性，构建了具有 95%置信区间（CI）的接收者操作特征（ROC）曲线，并建立了截断值。CRS 的截断值为-0.0345（曲线下面积 [AUC]=0.783，CI：0.713-0.853；p<0.001）。CRS 高于截断值的患者 RARP 术后并发症发生率高 16.4 倍（95%CI：5.58-48.5）。
E-PASS 评分模型通过使用患者术前身体状况和手术危险因素的术前数据成功预测 RARP 术后并发症。E-PASS 评分及其子评分可作为手术前后确定术后并发症风险的客观标准。
