Utilization and outcomes of minimally invasive radical prostatectomy
Utilization and outcomes of minimally invasive radical prostatectomy
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DOI：
10.1200/jco.2007.13.4528
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发表时间：
2008-05-10
影响因子：
45.3
通讯作者：
Keating, Nancy L.
中科院分区：
文献类型：
--
作者：
Hu, Jim C.;Wang, Qin;Keating, Nancy L.
微创根治性前列腺切除术（MIRP）治疗前列腺癌的需求正在增加，然而，结果仍然不清楚。我们评估了利用率，并发症，住院时间和挽救治疗率MIRP与开放根治性直肠癌切除术评估是否MIRP外科医生的体积与更好的outcomes.MethodsWe确定了2,702名男子进行MIRP和开放根治性直肠癌切除术在2003年至2005年从全国5%的医疗保险受益人的样本。我们评估了手术方法和结果之间的关联，调整外科医生的数量，年龄，种族，合并症，和地理region.ResultsMIRP利用率从2003年的12.2%增加到2005年的31.4%。与开放性根治性直肠癌切除术相比，接受MIRP的男性围手术期并发症较少（29.8% vs36.4%; P = 0.002），住院时间较短（1.4 vs4.4天; P <0.001）;然而，他们更可能接受挽救治疗（27.8% vs9.1%，P <0.001）。在校正分析中，MIRP与开放性根治性直肠癌切除术相比，围手术期并发症较少（比值比[OR]，0.73; 95% CI，0.60 - 0.90），住院时间缩短（参数估计值，-2.99; 95% CI，-3.45至-2.53）但吻合口狭窄更多（OR，1.40; 95% CI，1.04 - 1.87）和较高的挽救治疗率（OR，3.67; 95% CI，2.81 - 4.81）。高容量MIRP患者的吻合口狭窄较少（OR，0.93; 95% CI，0.87 - 0.99）和较少的挽救治疗（OR，0.92;结论MIRP与开放根治性直肠癌切除术相比，具有围手术期并发症发生率低、住院时间短的优点，但挽救治疗和吻合口狭窄的风险更高。然而，这些不利结局的风险随着MIRP手术量的增加而降低。
PurposeDemand for minimally invasive radical prostatectomy (MIRP) to treat prostate cancer is increasing; however, outcomes remain unclear. We assessed utilization, complications, lengths of stay, and salvage therapy rates for MIRP versus open radical prostatectomy assessed whether MIRP surgeon volume is associated with better outcomes.MethodsWe identified 2,702 men undergoing MIRP and open radical prostatectomy during 2003 to 2005 from a national 5% sample of Medicare beneficiaries. We assessed the association between surgical approach and outcomes, adjusting for surgeon volume, age, race, comorbidity, and geographic region.ResultsMIRP utilization increased from 12.2% in 2003 to 31.4% in 2005. Men undergoing MIRP versus open radical prostatectomy had fewer perioperative complications (29.8% v 36.4%; P = .002) and shorter lengths of stay (1.4 v 4.4 days; P < .001); however, they were more likely to receive salvage therapy (27.8% v 9.1%, P < .001). In adjusted analyses, MIRP versus open radical prostatectomy was associated with fewer perioperative complications (odds ratio [OR], 0.73; 95% CI, 0.60 to 0.90), shorter lengths of stay (parameter estimate, -2.99; 95% CI, -3.45 to -2.53) but more anastomotic strictures (OR, 1.40; 95% CI, 1.04 to 1.87) and higher rates of salvage therapy (OR, 3.67; 95% CI, 2.81 to 4.81). Patients of high-volume MIRP experienced fewer anastomotic strictures (OR, 0.93; 95% CI, 0.87 to 0.99) and less salvage therapy (OR, 0.92; 95% CI, 0.88 to 0.98).ConclusionMen undergoing MIRP versus open radical prostatectomy have lower risk for perioperative complications and shorter lengths of stay, but are at higher risk for salvage therapy and anastomotic strictures. However, risk for these unfavorable outcomes decreases with increasing MIRP surgical volume.