The impact of prostate gland weight in robot assisted Laparoscopic radical prostatectomy
The impact of prostate gland weight in robot assisted Laparoscopic radical prostatectomy
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DOI：
10.1016/j.juro.2008.05.029
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发表时间：
2008-09-01
影响因子：
6.6
通讯作者：
Wilson, Timothy G.
中科院分区：
文献类型：
--
作者：
Link, Brian A.;Nelson, Rebecca;Wilson, Timothy G.
目的：我们确定了前列腺重量是否有机器人辅助腹腔镜根治性前列腺切除术的病理和手术结果的影响。材料和方法：我们回顾了1,847例连续患者谁在我们的机构进行机器人辅助腹腔镜根治性前列腺切除术的记录。在按体重定义的前列腺大小的四分位数分布中比较变量，包括组1-小于30 gm，组2-30至49.9 gm，组3-50至69.9 gm和组4-70或更大gm。本分析中评估的因素包括患者年龄、体重指数、前列腺特异性抗原、格里森评分、病理分期、切缘状态、手术时间、失血量、输血率、住院时间和再住院率。结果：前列腺较大的患者（第4组）年龄较大，（平均年龄66.2岁），治疗前前列腺特异性抗原（中位数6.5 ng/ml），Gleason评分较低（平均6.3），手术时间较长（平均3.2小时），估计失血量较高（中位数250 cc）和住院时间较长（p = 0.0002）。根据D 'Amico风险分层和第1组中的阳性边缘状态，存在疾病风险更高的趋势，尽管第2组和第3组中囊外扩展的证据更常见。前列腺大小与体重指数、淋巴结状态、输血率、精囊受累和再住院率之间无相关性。结论：机器人辅助腹腔镜前列腺根治术是可行的，手术时间、尿漏率和住院时间稍长。病理上较大的前列腺通常与较低的Gleason评分和危险组分层相关。所有组的一年复发率和生化复发率相似。
Purpose: We determined whether prostate weight has an impact on the pathological and operative outcomes of robot assisted laparoscopic radical prostatectomy.Materials and Methods: We reviewed the records of 1,847 consecutive patients who underwent robot assisted laparoscopic radical prostatectomy at our institution. Variables were compared across quartile distributions of prostate size as defined by weight, including group 1-less than 30 gm, group 2-30 to 49.9, group 3-50 to 69.9 and group 4-70 or greater. Factors assessed in this analysis were patient age, body mass index, prostate specific antigen, Gleason score, pathological stage, margin status, operative time, blood loss, transfusion rate, length of stay and rehospitalization rate.Results: Patients with a larger prostate (group 4) were older (mean age 66.2 years), had higher pretreatment prostate specific antigen (median 6.5 ng/ml), lower Gleason score (mean 6.3), longer operative time (mean 3.2 hours), higher estimated blood loss (median 250 cc) and longer hospital stay (p = 0.0002). There was a trend toward higher risk disease based on D'Amico risk stratification and positive margin status in group 1, although evidence of extracapsular extension was more common in groups 2 and 3. There was no association between prostate size and body mass index, lymph node status, blood transfusion rate, seminal vesicle involvement and rehospitalization rate.Conclusions: Robot assisted laparoscopic, radical prostatectomy in patients with an enlarged prostate is feasible with slightly longer operative time, urinary leakage rates and hospital stay. Pathologically larger prostates are generally associated with lower Gleason score and risk group stratification. One-year continence rates and biochemical recurrence rates are similar across all groups.