Retzius Sparing Robot-Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score Matched Analysis of 1,863 Patients
Retzius Sparing Robot-Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score Matched Analysis of 1,863 Patients
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DOI：
10.1097/ju.0000000000000461
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发表时间：
2020-01-01
影响因子：
6.6
通讯作者：
Rha, Koon Ho
中科院分区：
文献类型：
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作者：
Lee, Jongsoo;Kim, Ha Yan;Rha, Koon Ho
目的：比较机器人辅助前列腺癌根治术和传统机器人辅助根治术的术后早期可控性恢复情况。材料和方法：2005年10月至2018年5月，1名外科医生分别采用传统和保留Retzius术式进行了1863例前列腺癌根治术，其中1150例采用保留机器人技术，713例采用保留机器人技术。采用年龄、体重指数、前列腺特异性抗原、病理Gleason分级、临床T分期、经直肠超声前列腺体积、国际前列腺症状评分(I-PSS)、I-PSS生活质量评分、国际勃起功能指数-5等9项指标，进行倾向性评分匹配。结果：经倾向性评分匹配后，每组609例患者全部匹配，9个变量均无显着性差异。Kaplan-Meier曲线分析显示，在6个月的研究期间，保留雷祖斯机器人辅助的前列腺癌根治术的可控性恢复率显著高于传统的机器人辅助前列腺癌根治术(p<；0.001)。结论：基于多变量和大病例系列的倾向评分匹配，保留雷祖斯机器人辅助的前列腺癌根治术有望成为未来机器人辅助前列腺癌根治术的候选方案。与传统的机器人辅助前列腺癌根治术相比，该手术获得了更好的早期可控性恢复，手术时间短，早期恢复。
Purpose: We compared early continence recovery after surgical treatment of prostate cancer with Retzius sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy.Materials and Methods: Robot-assisted radical prostatectomy was done by a single surgeon in 1,863 cases between October 2005 and May 2018 using the conventional and the Retzius sparing technique in 1,150 and 713, respectively. To compare continence outcomes between the groups propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate specific antigen, biopsy Gleason Grade Group, clinical T stage, prostate volume on transrectal ultrasound, and the I-PSS (International Prostate Symptom Score), I-PSS quality of life score and International Index of Erectile Function-5 scores. Continence was assessed by the pad count every month postoperatively until month 6 and was converted to a binary outcome.Results: After propensity score matching 609 cases per group were matched with no significant difference in all 9 variables. The Kaplan-Meier curve analysis revealed that Retzius sparing robot-assisted radical prostatectomy was associated with a significantly better continence recovery rate than conventional robot-assisted radical prostatectomy during the 6-month study period (p < 0.001).Conclusions: Based on propensity score matching with multiple variables and a large case series, Retzius sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy. It achieves better early continence recovery, a short operative time and early recovery compared to conventional robot-assisted radical prostatectomy.