Lymphocele after extraperitoneal robot-assisted radical prostatectomy: A propensity score-matching study
Lymphocele after extraperitoneal robot-assisted radical prostatectomy: A propensity score-matching study
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DOI：
10.1111/iju.12144
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发表时间：
2013-12-01
影响因子：
2.6
通讯作者：
Choi, Young Deuk
中科院分区：
文献类型：
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作者：
Lee, Joo Yong;Diaz, Richilda Red;Choi, Young Deuk
ObjectivesTo investigate lymphocele的发病率，并确定术后淋巴囊肿腹膜外机器人辅助根治性前列腺癌切除术后的危险因素，通过使用倾向评分matching.MethodsA共483例患者进行腹膜外机器人辅助根治性前列腺癌切除术2009年1月至2011年8月。其中，200例患者在机器人辅助根治性盆腔淋巴结切除术期间接受了盆腔淋巴结清扫。所有患者术后均接受磁共振成像或计算机断层扫描，以检测机器人辅助根治性直肠癌切除术后的淋巴囊肿。为建立对照组的倾向得分计算为每个患者使用多变量logistic回归的基础上，以下协变量：年龄，体重指数，术前前列腺特异性抗原水平，前列腺体积计算经直肠超声，活检Gleason总和和临床肿瘤stage.ResultsLymphocele被确定在41例（20.5%）。倾向评分匹配中使用的变量无统计学差异。两组的手术时间、估计失血量、导管插入和手术切缘阳性率无差异。两组间的精囊浸润（P=0.015）和肿瘤体积（P=0.042）差异有统计学意义。在多变量logistic回归模型中，囊外扩张（P=0.017，比值比4.231），精囊浸润（P= 0.028，OR 2.643）和阳性淋巴结数（P=0.041，比值比3.532）是腹膜外机器人术后淋巴囊肿发生的独立危险因素，结论淋巴囊肿易发生于肿瘤体积较大、侵犯精囊的患者。此外，囊外扩张、精囊浸润和阳性淋巴结数量是腹膜外机器人辅助根治性直肠癌切除术后淋巴囊肿的独立危险因素。
ObjectivesTo investigate the incidence of lymphocele and determine the risk factors for postoperative lymphocele after extraperitoneal robot-assisted radical prostatectomy by using propensity score-matching.MethodsA total of 483 patients underwent extraperitoneal robot-assisted radical prostatectomy for prostate cancer between January 2009 and August 2011. Of these, 200 patients underwent pelvic lymph node dissection during robot-assisted radical prostatectomy. All patients underwent magnetic resonance imaging or computed tomography postoperatively to detect lymphocele after robot-assisted radical prostatectomy. Propensity scores for an established control group were calculated for each patient using multivariate logistic regression based on the following covariates: age, body mass index, preoperative prostate-specific antigen level, prostate volume calculated by transrectal ultrasound, biopsy Gleason sum and clinical tumor stage.ResultsLymphocele was identified in 41 patients (20.5%). There were no statistical differences in variables used in propensity score-matching. Operation time, estimated blood loss, catheterization and surgical margin positivity did not show differences between the two groups. Seminal vesicle invasion (P=0.015) and tumor volume (P=0.042) between the two groups were significantly different. In the multivariate logistic regression model, extracapsular extension (P=0.017, odds ratio 4.231), seminal vesicle invasion (P=0.028, odds ratio 2.643) and the number of positive lymph nodes (P=0.041, odds ratio 3.532) were independent risk factors for lymphocele development after extraperitoneal robot-assisted radical prostatectomy with pelvic lymph node dissection.ConclusionsLymphocele might preferentially develop in cases with seminal vesicle invasion and large tumor volume. Additionally, extracapsular extension, seminal vesicle invasion, and the number of positive lymph nodes are independent risk factors for postoperative lymphocele after extraperitoneal robot-assisted radical prostatectomy.