Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men
Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men
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DOI：
10.1200/jco.2011.36.8621
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发表时间：
2012-02-10
影响因子：
45.3
通讯作者：
Fowler, Floyd J., Jr.
中科院分区：
文献类型：
--
作者：
Barry, Michael J.;Gallagher, Patricia M.;Fowler, Floyd J., Jr.
目的：机器人辅助腹腔镜根治性前列腺癌切除术在临床局限性前列腺癌患者中的应用已超过开放性根治性前列腺癌切除术。本研究的目的是比较这些程序之间Medicare-age men.Patients and MethodsA人口为基础的随机抽样的风险问题与性功能，从2008年8月1日至2008年12月31日的20%的医疗保险索赔文件。参与者有根治性前列腺切除术和前列腺癌诊断代码的医院和医生声明，并报告接受了机器人或开放式手术。他们收到的邮件调查，包括自我评级的问题，与生殖器和性功能的中位数为14个月postoperatives.ResultsCompleted调查获得685（86%）的797名合格的参与者，和406和220例患者报告有机器人或开放手术，分别。总体而言，607名男性中有189名（31.1%; 95%CI，27.5%至34.8%）报告有中度或重度性功能问题，593名男性中有522名（88.0%; 95%CI，85.4%至90.6%）报告有中度或重度性功能问题。在logistic回归模型中，预测术后复发的中度或严重问题的对数几率，并调整年龄和教育水平，机器人直肠癌切除术与复发的更大问题的非显著趋势相关（比值比[ OR] 1.41; 95%CI，0.97至2.05）。机器人乳房切除术与性功能问题无关（OR，0.87; 95%CI，0.51至1.49）。结论两种手术后乳房和性功能问题的风险都很高。医疗保险年龄的男性不应该期望机器人乳房切除术后的不良反应会减少。J Clin Oncol 30：513-518. (C)2012年美国临床肿瘤学会
PurposeRobotic-assisted laparoscopic radical prostatectomy is eclipsing open radical prostatectomy among men with clinically localized prostate cancer. The objective of this study was to compare the risks of problems with continence and sexual function following these procedures among Medicare-age men.Patients and MethodsA population-based random sample was drawn from the 20% Medicare claims files for August 1, 2008, through December 31, 2008. Participants had hospital and physician claims for radical prostatectomy and diagnostic codes for prostate cancer and reported undergoing either a robotic or open surgery. They received a mail survey that included self-ratings of problems with continence and sexual function a median of 14 months postoperatively.ResultsCompleted surveys were obtained from 685 (86%) of 797 eligible participants, and 406 and 220 patients reported having had robotic or open surgery, respectively. Overall, 189 (31.1%; 95% CI, 27.5% to 34.8%) of 607 men reported having a moderate or big problem with continence, and 522 (88.0%; 95% CI, 85.4% to 90.6%) of 593 men reported having a moderate or big problem with sexual function. In logistic regression models predicting the log odds of a moderate or big problem with postoperative continence and adjusting for age and educational level, robotic prostatectomy was associated with a nonsignificant trend toward greater problems with continence (odds ratio [ OR] 1.41; 95% CI, 0.97 to 2.05). Robotic prostatectomy was not associated with greater problems with sexual function (OR, 0.87; 95% CI, 0.51 to 1.49).ConclusionRisks of problems with continence and sexual function are high after both procedures. Medicare-age men should not expect fewer adverse effects following robotic prostatectomy. J Clin Oncol 30:513-518. (C) 2012 by American Society of Clinical Oncology