Department of Urology, University of Illinois at Chicago, Chicago, IL, USA; Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
Department of Urology, University of Illinois at Chicago, Chicago, IL, USA; Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Eur J Surg Oncol. 2024 Dec;50(12):108741. doi: 10.1016/j.ejso.2024.108741. Epub 2024 Oct 4.
The rise of frail patients in the worldwide population poses a challenge in the prostate cancer surgical care. In this light, we aimed to compare perioperative and early surgical outcomes of Extraperitoneal Single Port (SP)- vs Transperitoneal Multiport (MP) - Robot Assisted Radical Prostatectomy (RALP) in different frailty settings.
Clinical and surgical data of all consecutive patients treated with RALP between March 2014 and October 2023 were gathered. Propensity score matching was performed to adjust for potential baseline pre-operative confounders. The 5-miFI score was calculated for each patient and then five risk categories were identified (5-mFI score = 0, 1,2,3 and ≥ 4).
A total of 549 patients were assessed in the unmatched analysis. After the propensity score, 126 patients for each treatment group were matched. When stratified in different frailty-groups, 30-days postoperative complications occurred significantly more frequently in case of 5-mFI score=3 and >4 (p = 0.001). Moreover, higher rate of both overall (52 vs 23 %, p = 0.01) and major (19.6 vs 8.2 %, p = 0.02) postoperative complications was found in these patients in case of transperitoneal MP RARP as compared to the extraperitoneal SP procedures. Exploring predictors of postoperative early complications in patients with 5-mFI score = 3 and 4, extraperitoneal SP robotic approach showed a significant protective role on both overall (OR 0.21, p = 0.001) and major (OR 0.33, p = 0.001) complications occurrence.
In a matched cohort of patients treated with Robot Assisted Radical Prostatectomy, extraperitoneal Single Port approach significantly reduced the overall and major early complications rate in frail patients.
全球人口中虚弱患者的增加给前列腺癌手术治疗带来了挑战。有鉴于此，我们旨在比较不同虚弱程度下经腹腔和经腹腔多端口机器人辅助根治性前列腺切除术（RALP）的围手术期和早期手术结果。
收集了 2014 年 3 月至 2023 年 10 月期间所有接受 RALP 治疗的连续患者的临床和手术数据。采用倾向评分匹配来调整潜在的术前混杂因素。为每位患者计算 5-mFI 评分，然后确定五个风险类别（5-mFI 评分=0、1、2、3 和≥4）。
在未匹配分析中，共评估了 549 例患者。在进行倾向评分后，为每组治疗组匹配了 126 例患者。当按不同虚弱程度分层时，5-mFI 评分为 3 和>4 的患者术后 30 天并发症发生率显著更高（p=0.001）。此外，与经腹腔 MP RARP 相比，这些患者的总（52%比 23%，p=0.01）和主要（19.6%比 8.2%，p=0.02）术后并发症发生率更高。在 5-mFI 评分为 3 和 4 的患者中，探讨术后早期并发症的预测因素，经腹腔 SP 机器人方法在总（OR 0.21，p=0.001）和主要（OR 0.33，p=0.001）并发症发生方面均表现出显著的保护作用。
在接受机器人辅助根治性前列腺切除术治疗的匹配患者队列中，经腹腔单端口方法显著降低了虚弱患者的总并发症和主要早期并发症发生率。
