Hinojosa-Gonzalez David E, Hernandez Beatriz S, Salgado Garza Gustavo, Lowry Katherine A, Saffati Gal, Tapia Katherine, Wolpert John, Slawin Bailey R, Slawin Jeremy R
Scott Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA.
Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
J Robot Surg. 2025 Apr 21;19(1):166. doi: 10.1007/s11701-025-02342-0.
Prostate cancer (PCa), the second most common cancer in men, is typically diagnosed between ages 65 and 74. When planning radical prostatectomy, patient frailty and nutritional status must be carefully evaluated. This study investigates the association between frailty, malnutritional status, and postprostatectomy complications in PCa patients. We analyzed the ACS-NSQIP prostatectomy series (2019-2022), focusing on minimally invasive procedures, including only malignant neoplasm diagnoses. The modified 5-index frailty (mFI-5) was calculated, where values of 2 or higher indicated frailty. Nutritional risk was assessed using a Nutritional Risk Index (NRI) of ≤ 97.5 and preoperative hypoalbuminemia (≤ 3.5) as indicators of malnutrition. Incomplete records were excluded, and remaining data were analyzed using R 4.3.3. The study included 21,067 patients. Compared to non-frail patients, frail individuals were significantly older and showed higher rates of diabetes, smoking, elevated BMI, and ASA scores > 2 (all p < 0.001). Frail patients also experienced longer hospital stays and operative times (p < 0.001), along with higher rates of renal insufficiency (p = 0.018), urinary infections (p = 0.001), systemic shock (p = 0.003), and overall complications (p = 0.002) compared to non-frail patients. Of the 9,932 patients evaluated for nutritional status, 342 met malnutrition criteria. Those identified by NRI criteria, experienced longer hospital stays and higher rates of myocardial infarction, and those identified by low albumin levels, showed increased length of stay (p = 0.044), major complications (p = 0.013), and rates of return to the operating room (p = 0.005), when compared to the normal cohort. Frailty and malnutrition are independent risk factors for postoperative complication in minimally invasive prostatectomy, highlighting the need for preoperative optimization.
前列腺癌（PCa）是男性中第二常见的癌症，通常在65至74岁之间被诊断出来。在计划根治性前列腺切除术时，必须仔细评估患者的虚弱程度和营养状况。本研究调查了PCa患者的虚弱、营养不良状态与前列腺切除术后并发症之间的关联。我们分析了美国外科医师学会国家外科质量改进计划（ACS-NSQIP）前列腺切除术系列（2019 - 2022年），重点关注微创手术，仅包括恶性肿瘤诊断。计算改良的5指标虚弱指数（mFI-5），其中值为2或更高表示虚弱。使用营养风险指数（NRI）≤97.5和术前低白蛋白血症（≤3.5）作为营养不良的指标来评估营养风险。排除不完整记录，使用R 4.3.3分析剩余数据。该研究纳入了21,067名患者。与非虚弱患者相比，虚弱个体年龄显著更大，且糖尿病、吸烟、BMI升高和美国麻醉医师协会（ASA）评分>2的发生率更高（所有p<0.001）。虚弱患者的住院时间和手术时间也更长（p<0.001），与非虚弱患者相比肾功能不全（p = 0.018）、泌尿系统感染（p = 0.001）、全身休克（p = 0.003）和总体并发症（p = 0.002）的发生率更高。在9,932名接受营养状况评估的患者中，342名符合营养不良标准。与正常队列相比，那些符合NRI标准的患者住院时间更长，心肌梗死发生率更高，而那些因低白蛋白水平被认定的患者住院时间延长（p = 0.044）、主要并发症发生率更高（p = 0.013）以及返回手术室的发生率更高（p = 0.005）。虚弱和营养不良是微创前列腺切除术后并发症的独立危险因素，凸显了术前优化的必要性。
