接受达芬奇机器人辅助前列腺癌根治术的肥胖患者的围手术期、功能和肿瘤治疗效果：系统回顾和荟萃分析。

IF 1.7 3区医学 Q3 UROLOGY & NEPHROLOGY

BMC Urology Pub Date : 2024-09-23 DOI:10.1186/s12894-024-01595-5

Chong-Jian Wang, Jiao Qin, Yang Liu, Zhi Wen, Cai-Xia Chen, Hong-Yuan Li, Hao-Tian Huang, Lin Yang, Xue-Song Yang

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引用次数: 0

摘要

目的：机器人辅助前列腺癌根治术（RARP）对肥胖（OB）和非肥胖（NOB）前列腺癌患者的影响仍是一个争论不休的话题。本研究的目的是将肥胖和非肥胖前列腺癌患者的机器人辅助根治性前列腺切除术的围手术期、功能和肿瘤学结果进行对比：我们系统地检索了 PubMed、Embase、Web of Science 和 Cochrane Library 数据库等数据库，以确定截至 2023 年 9 月以英文发表的相关研究。使用Review Manager对各种参数进行比较。该研究已在 PROSPERO（CRD42023473136）注册。共纳入16项比较试验，对8434名肥胖患者和55266名非肥胖患者进行了比较：肥胖组的手术时间更长（WMD 17.8 分钟，95% CI 9.7-25.8; p 结论：肥胖组的围手术期更长（WMD 17.8 分钟，95% CI 9.7-25.8; p）：在肥胖组中，RARP 的围手术期预后、总并发症、功能预后和肿瘤预后均较差。RARP术前减肥可能是改善患者预后的可行策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Perioperative, functional, and oncologic outcomes in obese patients undergoing Da Vinci robot-assisted radical prostatectomy: a systematic review and meta-analysis.

Objective: The influence of robot-assisted radical prostatectomy (RARP) in obese (OB) and non-obese (NOB) prostate cancer patients remains a topic of debate. The objective of this study was to juxtapose the perioperative, functional, and oncologic outcomes of RARP in OB and NOB cohorts.

Materials and methods: We systematically searched the databases such as PubMed, Embase, Web of Science, and the Cochrane Library database to identify relevant studies published in English up to September 2023. Review Manager was used to compare various parameters. The study was registered with PROSPERO (CRD42023473136). Sixteen comparative trials were included for 8434 obese patients compared with 55,266 non-obese patients.

Results: The OB group had a longer operative time (WMD 17.8 min, 95% CI 9.7,25.8; p < 0.0001), a longer length of hospital stay (WMD 0.18 day, 95% CI 0.12,0.24; p < 0.00001, a higher estimated blood loss (WMD 50.6 ml, 95% CI 11.7,89.6; p = 0.01), and higher pelvic lymphadenectomy rate (RR 1.08, 95% CI 1.04,1.12; p < 0.0001)and lower nerve sparing rate (RR 0.95, 95% CI 0.91,0.99; p < 0.01), but there was no difference between unilateral (RR 1.0, 95% CI 0.8,1.3; p = 0.8)and bilateral (RR 0.9, 95% CI 0.9,1.0; p = 0.06)nerve sparing rate. Then, complication rates (RR 1.6, 95% CI 1.5,1.7; p < 0.00001) were higher in the OB group, and both major (RR 1.4, 95% CI 1.1,1.8; p = 0.01)and minor (RR 1.4, 95% CI 1.1,1.7; p < 0.01)complication rates were higher in the OB group. Moreover, obese patients showed significantly higher probabilities of incontinence (RR 1.17, 95% CI 1.03,1.33; p = 0.01) and impotency (RR 1.08, 95% CI 1.01,1.15; p = 0.02) at 1 year. Last, the positive surgical margin (RR 1.2, 95% CI 1.1,1.3; p < 0.01) was higher in the OB group.

Conclusion: In the obese group, perioperative outcomes, total complications, functional outcomes, and oncologic outcomes were all worse for RARP. Weight loss before RARP may be a feasible strategy to improve the prognosis of patients.

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来源期刊

BMC Urology UROLOGY & NEPHROLOGY-

CiteScore

3.20

自引率

0.00%

发文量

177

审稿时长

>12 weeks

期刊介绍： BMC Urology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of urological disorders, as well as related molecular genetics, pathophysiology, and epidemiology. The journal considers manuscripts in the following broad subject-specific sections of urology: Endourology and technology Epidemiology and health outcomes Pediatric urology Pre-clinical and basic research Reconstructive urology Sexual function and fertility Urological imaging Urological oncology Voiding dysfunction Case reports.