Prostate size is associated with surgical difficulty but not functional outcome at 1 year after radical prostatectomy.
Prostate size is associated with surgical difficulty but not functional outcome at 1 year after radical prostatectomy.
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DOI：
10.1016/j.juro.2009.05.029
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发表时间：
2009-09
期刊：
影响因子：
--
通讯作者：
Rabbani F
中科院分区：
文献类型：
--
作者：
Pettus JA;Masterson T;Sokol A;Cronin AM;Savage C;Sandhu JS;Mulhall JP;Scardino PT;Rabbani F
我们试图评估前列腺大小对手术难度的影响，通过估计失血量（EBL）、手术室（OR）时间和阳性手术切缘（SM）来衡量，其次评估对生化复发（BCR）的影响，以及根治性前列腺切除术（RP）后1年时的功能结局和膀胱颈挛缩（BNC）。在1998-2007年期间，3067名男性在5名专门的前列腺外科医生中的一名接受了RP，没有新辅助或辅助治疗。使用病理标本重量作为前列腺大小的衡量标准。分别采用考克斯比例风险和逻辑回归分析研究标本重量与生化复发（BCR）和SM状态之间的相关性，控制不良病理特征。控制年龄、神经保留状态和手术方法，分析尿失禁和性功能。随着前列腺大小的增加，EBL（p=0.013）和OR时间（p=0.004）增加，阳性SM减少（≤ 40 g为84/632（14%），41- 50 g为99/862（12%），51- 65 g为78/842（10%），> 65 g为68/731（10%）（p<0.001））。在术后随访的2882例患者中，有186例观察到BCR，与标本重量无显著相关性（p=0.3）。在1年时，在1165/1422（82%）中观察到完全消除，在425/827（51%）中观察到效价。标本重量与效价（p=0.8）、效价（p=0.08）或BNC（p=0.22）无显著相关性。前列腺大小似乎不影响生化复发或一年功能结果。然而，EBL和OR时间随着前列腺体积的增大而增加，并且在较小的腺体中更常观察到阳性SM。
We sought to assess the impact of prostate size on operative difficulty as measured by estimated blood loss (EBL), operating room (OR) time and positive surgical margins (SM) and secondarily to assess the impact on biochemical recurrence (BCR) and the functional outcomes of potency and continence at one year following radical prostatectomy (RP) as well as postoperative bladder neck contracture (BNC). During 1998–2007, 3067 men underwent RP by one of 5 dedicated prostate surgeons with no neoadjuvant or adjuvant therapy. Pathologic specimen weight was used as a measure of prostate size. Cox proportional hazards and logistic regression analysis was used to study the association between specimen weight and biochemical recurrence (BCR) and SM status, respectively, controlling for adverse pathologic features. Continence and potency were analyzed controlling for age, nerve-sparing status, and surgical approach. With increasing prostate size, there was increased EBL (p=0.013) and OR time (p=0.004) and a decrease in positive SM (84/632 (14%) for ≤40g, 99/862 (12%) for 41–50g, 78/842 (10%) for 51–65g, 68/731 (10%) for >65g (p<0.001)). BCR was observed in 186 of 2882 patients followed postoperatively and was not significantly associated with specimen weight (p=0.3). Complete continence was observed in 1165/1422 (82%) and potency in 425/827 (51%) at one year. Specimen weight was not significantly associated with potency (p=0.8), continence (p=0.08) or BNC (p=0.22). Prostate size does not appear to affect biochemical recurrence or one-year functional results. However, EBL and OR time increased with larger prostate size and positive SM are more often observed in smaller glands.
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