The Impact of Prostate Size on Perioperative Outcomes in a Large Laparoscopic Radical Prostatectomy Series
| Autor: | Nicholas T. Ward, Li-Ming Su, Aaron Sulman, Christian P. Pavlovich, Richard E. Link, Adam W. Levinson, Lynda Z. Mettee |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Nephrology Laparoscopic surgery medicine.medical_specialty Laparoscopic radical prostatectomy Urology medicine.medical_treatment Perioperative Care Prostate Internal medicine medicine Humans Aged Prostatectomy business.industry Organ Size Perioperative Middle Aged Prostate size Specimen weight Surgery Treatment Outcome medicine.anatomical_structure Multivariate Analysis Laparoscopy lipids (amino acids peptides and proteins) business |
| Zdroj: | Journal of Endourology. 23:147-152 |
| ISSN: | 1557-900X 0892-7790 |
| DOI: | 10.1089/end.2008.0366 |
| Popis: | To clarify the effects of pathologic prostate specimen weight on perioperative outcomes in laparoscopic radical prostatectomy (LRP), a subject that has recently been analyzed in numerous smaller series.Data from our Institution Review Board-approved database was queried with attention to operative, perioperative, and pathologic outcomes. For analysis, LRP patients were divided into three groups by pathologic specimen weight:35 g, 35 to 70 g, and70 g, and outcomes assessed. Outcomes were also analyzed using prostate weight as a continuous variable by multivariate regression.Between April 2001 and April 2007, 802 consecutive patients underwent LRP for localized prostate cancer, and complete perioperative data were available for 720 (90%) of these men. Mean age, body mass index (BMI), preoperative prostate-specific antigen (PSA) and postoperative Gleason score were 57.6 years, 26.7 kg/m(2), 5.9 ng/mL, and 6.3, respectively. Mean specimen weight was 51.3 g. When compared with lighter counterparts, patients with the heaviest glands were older (P0.01), had a higher PSA level (P0.01), and had a higher percentage of pathologically organ-confined disease (P0.01). By multivariate regression analysis, increasing prostate weight was associated with longer operative times, more blood loss, longer lengths of stay, and more perioperative complications (all P0.05). Of note, smaller glands trended toward a higher rate of positive surgical margins overall (P = 0.07) and in pT(2) disease (P = 0.05), but there was no association between surgical margins and gland size in pT(3) disease (P = 0.27). Increasing BMI was also independently predictive of positive margins regardless of prostate size (P0.01).Although perioperative outcomes are generally excellent after LRP irrespective of gland size, a larger prostate size is associated with longer operative time, more blood loss, longer length of stay, and increased complications. Patients with smaller glands and organ-confined disease appear to have a higher rate of positive surgical margins. |
| Databáze: | OpenAIRE |
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