比较围手术期和早期肿瘤学的结果之间的开放和当代基于人口队列的机器人辅助腹腔镜前列腺切除术

比较围手术期和早期肿瘤学的结果之间的开放和当代基于人口队列的机器人辅助腹腔镜前列腺切除术
Comparison of Perioperative and Early Oncologic Outcomes between Open and Robotic Assisted Laparoscopic Prostatectomy in a Contemporary Population Based Cohort

Abstract
摘要
PURPOSE:
目的：
We compared rates of positive surgical margins, use of postoperative radiation therapy, and perioperative outcomes between robotic assisted laparoscopic and open radical prostatectomy in a contemporary population based cohort.
我们比较了手术切缘阳性率，术后放射治疗的应用，机器人辅助腹腔镜与开放根治性前列腺切除术在当代人群队列研究中的围手术期结果。

MATERIALS AND METHODS:
材料与方法：
In the National Cancer Data Base from 2010 through 2011 patients who underwent robotic assisted laparoscopic prostatectomy (73,131) and open radical prostatectomy (23,804) for nonmetastatic prostate adenocarcinoma were identified. Covariates included age, race, Charlson comorbidity index, prostate specific antigen, biopsy Gleason score, clinical stage, final Gleason score, pathological T stage, lymph node dissection, nodal status, facility type, hospital volume and year of surgery. Multivariable logistic regression was used to identify factors associated with positive surgical margins, use of adjuvant/salvage radiation therapy, prolonged length of stay, readmission and 30-day mortality. Outcomes were also compared in 1:1 propensity matched cohorts.
在2010至2011例接受机器人辅助腹腔镜前列腺切除术的国家癌症数据库中（73131）和开放根治性前列腺切除术（23804）的非转移性前列腺癌进行鉴别。变量包括年龄、种族、Charlson合并症指数、前列腺特异性抗原，病理格里森评分、临床分期、最终格里森评分、病理T分期、淋巴结清扫术、淋巴结状态、设备类型、医院规模和一年的手术。多变量逻辑回归分析用于识别与手术切缘阳性相关的因素，使用辅助/抢救放射治疗，住院时间延长，住院和30天死亡率。结果进行了比较在1:1倾向匹配队列。

RESULTS:
结果:
Analysis of propensity matched cohorts showed robotic assisted laparoscopic prostatectomy reduced the risk of positive surgical margins (OR 0.88, 95% CI 0.83-0.93, p <0.01), the use of radiation therapy (OR 0.71, 95% CI 0.63-0.80, p <0.01) and 30-day mortality (OR 0.28, 95% CI 0.13-0.60, p <0.01). The protective effect of robotic assisted laparoscopic prostatectomy for positive surgical margins was found in patients with pT2 disease only (pT2-OR 0.85, 95% CI 0.79-0.91, p <0.01; pT3-OR 0.94, 95% CI 0.86-1.04, p=0.2). Similar results were obtained using multivariable regression.
倾向匹配队列分析显示机器人辅助腹腔镜前列腺切除术减少切缘阳性的风险（OR 0.88，95% CI 0.83-0.93，P＜0.01），使用放射治疗（OR 0.71，95% CI 0.63-0.80，P＜0.01）和30天的死亡率（OR 0.28，95% CI 0.13-0.60，P＜0.01）。机器人辅助腹腔镜前列腺切除术后切缘阳性的保护作用被发现在pT2疾病仅（PT2或0.85，95% CI 0.79-0.91，P＜0.01；PT3或0.94，95% CI 0.86-1.04，P = 0.2）。使用多变量回归得到了类似的结果。

CONCLUSIONS:
结论：
In a contemporary large national cohort, robotic assisted laparoscopic prostatectomy was independently associated with clinically meaningful reductions in positive surgical margins, postoperative radiation therapy and 30-day mortality compared to open radical prostatectomy. The oncologic benefit was primarily in patients with organ confined disease. Limitations were those associated with any observational study, namely the potential for bias due to unmeasured confounders.
在一个当代的大型国家队列，机器人辅助腹腔镜前列腺切除术是独立相关的具有临床意义的降低手术切缘阳性，与开放性前列腺癌根治术术后放射治疗和30天死亡率比较。肿瘤学的好处主要是器官局限性疾病的患者。限制那些观察性研究有关，即潜在的偏见由于不可预测因素。

原文：
Comparison of Perioperative and Early Oncologic Outcomes between Open and Roboti.pdf (124.62 KB, 下载次数: 0, 售价: 99 香叶)

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比较围手术期和早期肿瘤学的结果之间的开放和当代基于人口队列的机器人辅助腹腔镜前列腺切除术