Safety and feasibility of outpatient robot-assisted radical prostatectomy
Safety and feasibility of outpatient robot-assisted radical prostatectomy
复制标题
DOI：
10.1007/s11701-018-0848-8
复制
发表时间：
2019-04-01
影响因子：
2.3
通讯作者：
Tamaddon, Kirk
中科院分区：
文献类型：
--
作者：
Banapour, Pooya;Elliott, Peter;Tamaddon, Kirk
自成立以来，机器人辅助根治性前列腺切除术（RARP）已发展成为一种熟悉的手术方式，改善了围手术期结局，包括减少了局限性前列腺癌患者的住院时间。早在2010年就报告了门诊RARP的经验。在这项研究中，我们通过比较接受门诊RARP的患者与术后第二天出院的患者之间的围手术期结局来评估门诊RARP的安全性和可行性。这是一项单机构回顾性队列研究。纳入了2017年9月至2018年1月接受RARP但未进行盆腔淋巴结清扫的局限性疾病患者。使用T检验和卡方分析比较手术当天出院的患者（门诊RARP）与手术后当天出院的患者（住院RARP）的人口统计学和围手术期特征。在纳入研究的51例患者中，26例接受了门诊RARP，25例接受了住院RARP。平均年龄无显著差异（61.4 vs 65.8岁，p=0.05），BMI（27.1 vs 28.3kg/m2，p=0.35）、种族、烟草使用（8 vs 15%，p=0.41），PSA（8.7 vs 8.4 ng/dL，p=0.77），活检Gleason评分分布，前列腺大小（51.8 vs 57.7cc，p=0.26）或术前血红蛋白（14.3 vs 13.4g/dL，p=0.06）。在接受门诊与住院RARP的患者之间，手术时间（95.3 vs 101 min，p=0.16）、EBL（52.8 vs 66.5cc，p=0.08）、术后血红蛋白变化（-1 vs -1.1g/dL，p=0.62）、病理分期分布或并发症发生率（4 vs 8%，p=0.58）均无显著差异。与住院RARP相比，门诊RARP提供了相似或改善的围手术期结局。我们提倡门诊RARP作为一种安全可行的替代住院RARP适当选择前列腺癌患者。此外，我们介绍了一个门诊模式，可以应用于其他机构寻求实施门诊RARP。
Since its inception, robot-assisted radical prostatectomy (RARP) has developed into a familiar surgical modality with improved perioperative outcomes including decreased hospital stay for localized prostate cancer patients. Experience with outpatient RARP has been reported as early as 2010. In this study, we evaluate the safety and feasibility of outpatient RARP by comparing perioperative outcomes between patients undergoing outpatient RARP to patients discharged on the day following surgery. This is a single-institution retrospective cohort study. Patients with localized disease who underwent RARP without pelvic lymph node dissection from September 2017 to January 2018 were included. T tests and Chi-squared analysis were used to compare demographic and perioperative characteristics of patients who were discharged on the same day of surgery (outpatient RARP) to patients discharged on the day after surgery (inpatient RARP). Of the 51 patients included in the study, 26 underwent outpatient RARP while 25 underwent inpatient RARP. There was no significant difference in mean age (61.4 vs 65.8years, p=0.05), BMI (27.1 vs 28.3kg/m(2), p=0.35), ethnicity, tobacco use (8 vs 15%, p=0.41), PSA (8.7 vs 8.4ng/dL, p=0.77), biopsy Gleason score distribution, prostate size (51.8 vs 57.7cc, p=0.26) or preoperative hemoglobin (14.3 vs 13.4g/dL, p=0.06), respectively. There was no significant difference between operative time (95.3 vs 101min, p=0.16), EBL (52.8 vs 66.5cc, p=0.08), postoperative change in hemoglobin (-1 vs -1.1g/dL, p=0.62), pathologic stage distribution or complication rate (4 vs 8%, p=0.58) between patients who underwent outpatient vs inpatient RARP, respectively. Outpatient RARP offers similar or improved perioperative outcomes when compared to inpatient RARP. We advocate outpatient RARP as a safe and feasible alternative to inpatient RARP for appropriately selected prostate cancer patients. Furthermore, we introduce an outpatient model that can be applied to other institutions seeking to implement outpatient RARP.