The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples
The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples
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DOI：
10.1016/j.juro.2015.08.092
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发表时间：
2016-02-01
影响因子：
6.6
通讯作者：
Penson, David F.
中科院分区：
文献类型：
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作者：
O'Neil, Brock;Koyama, Tatsuki;Penson, David F.
目的：尽管在疾病控制或功能性后遗症方面的优越性存在相互矛盾的证据，但机器人辅助根治性前列腺切除术在前列腺癌的手术治疗中已在很大程度上取代了开放根治性前列腺切除术。在这项研究中，我们使用人群队列数据检查了接受开放式根治性前列腺切除术的男性与接受机器人辅助根治性前列腺切除术的男性的性功能和泌尿功能。 材料和方法：接受前列腺癌手术治疗的受试者选自两项基于大型人群的前瞻性队列研究，即前列腺癌结果研究（1994年至1995年登记）和手术与放射治疗的比较有效性分析（2011年至2012年登记）。受试者完成基线、6 个月和 12 个月标准化患者报告的结果测量。主要结果是使用线性回归并根据基线功能、社会人口统计学和临床特征进行调整后，6 个月和 12 个月时功能结果评分的组间差异。敏感性分析用于评估 CEASAR 和 PCOS 内部和之间接受开放式根治性前列腺切除术和机器人辅助根治性前列腺切除术的患者之间的结果。结果：合并队列由 2,438 名男性组成，其中 1,505 人接受了开放式根治性前列腺切除术，其中 933 人接受了机器人辅助根治性前列腺切除术。接受机器人辅助根治性前列腺切除术治疗的男性在 6 个月时报告了更好的泌尿功能（平均差异 3.77 分，95% CI 1.09-6.44），但在 12 个月时则没有改善（1.19，-1.32-3.71）。接受机器人辅助根治性前列腺切除术治疗的受试者在 6 个月（8.31，6.02-10.56）和 12 个月（7.64，5.25-10.03）时也报告了良好的性功能。敏感性分析在很大程度上支持了性功能结果，但对泌尿功能结果的支持不一致。结论：这项基于人群的研究表明，接受机器人辅助根治性前列腺切除术的男性早期尿失禁和性功能的下降可能比接受开放性根治性前列腺切除术的男性要少。这些差异的临床意义尚不确定，需要更长时间的随访才能确定这些益处是否持久。
Purpose: Robotic assisted radical prostatectomy has largely replaced open radical prostatectomy for the surgical management of prostate cancer despite conflicting evidence of superiority with respect to disease control or functional sequelae. Using population cohort data, in this study we examined sexual and urinary function in men undergoing open radical prostatectomy vs those undergoing robotic assisted radical prostatectomy.Materials and Methods: Subjects surgically treated for prostate cancer were selected from 2 large population based prospective cohort studies, the Prostate Cancer Outcomes Study (enrolled 1994 to 1995) and the Comparative Effectiveness Analysis of Surgery and Radiation (enrolled 2011 to 2012). Subjects completed baseline, 6-month and 12-month standardized patient reported outcome measures. Main outcomes were between-group differences in functional outcome scores at 6 and 12 months using linear regression, and adjusting for baseline function, sociodemographic and clinical characteristics. Sensitivity analyses were used to evaluate outcomes between patients undergoing open radical prostatectomy and robotic assisted radical prostatectomy within and across CEASAR and PCOS.Results: The combined cohort consisted of 2,438 men, 1,505 of whom underwent open radical prostatectomy and 933 of whom underwent robotic assisted radical prostatectomy. Men treated with robotic assisted radical prostatectomy reported better urinary function at 6 months (mean difference 3.77 points, 95% CI 1.09-6.44) but not at 12 months (1.19, -1.32-3.71). Subjects treated with robotic assisted radical prostatectomy also reported superior sexual function at 6 months (8.31, 6.02-10.56) and at 12 months (7.64, 5.25-10.03). Sensitivity analyses largely supported the sexual function findings with inconsistent support for urinary function results.Conclusions: This population based study reveals that men undergoing robotic assisted radical prostatectomy likely experience less decline in early urinary continence and sexual function than those undergoing open radical prostatectomy. The clinical meaning of these differences is uncertain and longer followup will be required to establish whether these benefits are durable.