体弱患者的腹膜外单孔与经腹膜多孔机器人辅助前列腺癌根治术：倾向得分匹配比较分析

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2024-10-04 DOI:10.1016/j.ejso.2024.108741

Luca Lambertini , Matteo Pacini , Ruben Sauer Calvo , Luca Morgantini , Donato Cannoletta , Fabrizio Di Maida , Francesca Valastro , Andrea Mari , Gabriele Bignante , Francesco Lasorsa , Angelo Orsini , Alessandro Zucchi , Andrea Minervini , Simone Crivellaro

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引用次数: 0

摘要

目的：全球体弱患者人数的增加给前列腺癌手术治疗带来了挑战。有鉴于此，我们旨在比较不同体弱情况下腹膜外单孔（SP）与经腹膜多孔（MP）机器人辅助根治性前列腺切除术（RALP）的围手术期和早期手术效果：收集了2014年3月至2023年10月期间所有接受RALP治疗的连续患者的临床和手术数据。进行倾向评分匹配以调整潜在的术前基线混杂因素。计算每位患者的5-miFI得分，然后确定五个风险类别（5-miFI得分=0、1、2、3和≥4）：结果：共有 549 名患者接受了非匹配分析评估。经过倾向评分后，每个治疗组有 126 名患者进行了匹配。按不同体弱组进行分层后，5-mFI=3 分和大于 4 分的患者术后 30 天并发症发生率明显更高（P = 0.001）。此外，与腹膜外 SP 手术相比，经腹膜 MP RARP 患者术后总并发症（52% 对 23%，p = 0.01）和主要并发症（19.6% 对 8.2%，p = 0.02）的发生率都更高。在对5-mFI评分=3和4分的患者进行术后早期并发症预测时，腹膜外SP机器人方法对总体并发症（OR 0.21，p = 0.001）和主要并发症（OR 0.33，p = 0.001）的发生具有显著的保护作用：结论：在采用机器人辅助根治性前列腺切除术治疗的配对队列中，腹膜外单孔方法可显著降低体弱患者的总并发症和主要早期并发症发生率。

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Extraperitoneal Single Port vs Transperitoneal Multiport Robot assisted radical prostatectomy in frail patients: A propensity score matched comparative analysis

Purpose

The rise of frail patients in the worldwide population poses a challenge in the prostate cancer surgical care. In this light, we aimed to compare perioperative and early surgical outcomes of Extraperitoneal Single Port (SP)- vs Transperitoneal Multiport (MP) - Robot Assisted Radical Prostatectomy (RALP) in different frailty settings.

Materials and methods

Clinical and surgical data of all consecutive patients treated with RALP between March 2014 and October 2023 were gathered. Propensity score matching was performed to adjust for potential baseline pre-operative confounders. The 5-miFI score was calculated for each patient and then five risk categories were identified (5-mFI score = 0, 1,2,3 and ≥ 4).

Results

A total of 549 patients were assessed in the unmatched analysis. After the propensity score, 126 patients for each treatment group were matched. When stratified in different frailty-groups, 30-days postoperative complications occurred significantly more frequently in case of 5-mFI score=3 and >4 (p = 0.001). Moreover, higher rate of both overall (52 vs 23 %, p = 0.01) and major (19.6 vs 8.2 %, p = 0.02) postoperative complications was found in these patients in case of transperitoneal MP RARP as compared to the extraperitoneal SP procedures. Exploring predictors of postoperative early complications in patients with 5-mFI score = 3 and 4, extraperitoneal SP robotic approach showed a significant protective role on both overall (OR 0.21, p = 0.001) and major (OR 0.33, p = 0.001) complications occurrence.

Conclusions

In a matched cohort of patients treated with Robot Assisted Radical Prostatectomy, extraperitoneal Single Port approach significantly reduced the overall and major early complications rate in frail patients.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.