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Roboterassistierte radikale Prostatektomie

Vorteil bei adipösen Männern? – Eine Matched-pair-Analyse

DaVinci robot-assisted laparoscopic prostatectomy

Benefit for obese men? – A matched-pair analysis

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Zusammenfassung

Hintergrund

Die radikale retropubische Prostatektomie (RRP) bei adipösen Patienten („Body Mass Index“, BMI ≥ 30) ist mit erhöhter perioperativer Morbidität und schlechterem funktionellen Ergebnis assoziiert. Ziel dieser Studie ist es zu überprüfen, ob die roboterassistierte radikale Prostatektomie (RARP) bei adipösen Patienten eine geringere Morbidität und ein besseres funktionelles Ergebnis gegenüber der RRP ermöglicht.

Patienten und Methode

Wir identifizierten 255 Patienten mit einem Prostatakarzinom (PCA) und BMI ≥ 30, die zwischen 1/2009 und 12/2011 radikal prostatektomiert wurden. Per „propensity score matching“ anhand von Risikofaktoren für eine erhöhte perioperative Morbidität (Nerverhaltung, Lymphadenektomie, Prostatavolumen) wurden gleiche Paare (n = 115/Gruppe) gebildet. Beide Gruppen (RARP vs. RRP) wurden hinsichtlich ihres histopathologischen Ergebnisses, peri- und postoperativen (30 Tage) Morbidität und Kontinenz und Potenz verglichen.

Ergebnisse

Es zeigte sich kein Unterschiede bezüglich der histopathologischen Charakteristika in beiden Gruppen (pT/pN-Stadien, Gleason-Grad, R-Status; alle p > 0,05). Mittlerer Blutverlust (276 ml vs. 937 ml), Transfusionsrate (0,9 % vs. 8,7 %) sowie die Rate der 30-Tage-Komplikationen nach der Clavien-Klassifikation (Clavien ≥ 2; 9,5 % vs. 22,6 %) waren niedriger in der RARP-Gruppe gegenüber RRP (alle p < 0,05). In einem multivariaten logistischen Regressionsmodell zeigte sich RARP vs. RRP signifikant (protektiv) mit dem Risiko einer Komplikation Clavien ≥ 2 assoziiert (Odds Ratio, OR = 0,3; p = 0,005). In der Analyse der postoperativen Kontinenz zeigte die Rate der 3-Monats-Ergebnisse ein Vorteil zugunsten der RARP-Patienten (p = 0,02). Die Auswertung der postoperativen Potenz zeigte keinen signifikanten Unterschied.

Schlussfolgerung

Unsere Beobachtung bezüglich geringerer Transfusions- und Komplikationsraten sowie einem Trend einer besseren postoperativen Frühkontinenz bei RARP sollte in der Therapieberatung von PCA-Patienten mit einem hohen BMI berücksichtigt werden.

Abstract

Background

Open radical retropubic prostatectomy (RRP) in obese patients (BMI ≥30) is associated with increased perioperative morbidity. The aim of the study was to evaluate the possible benefit of DaVinci robotic-assisted laparoscopic prostatectomy (RARP) compared to RRP in obese patients.

Patients and methods

We identified 255 patients with a localized prostate cancer (PCa) and BMI ≥30 treated with radical prostatectomy from January 2009 to December 2011. To adjust for risk factors of increased perioperative morbidity (nerve-sparing, pelvic lymph node dissection, prostate volume), a propensity score-based matching was performed between RRP and RARP (n=115 each group). Both groups were compared by taking into consideration histopathological outcomes as well as peri- and postoperative (30 days) morbidity.

Results

There were no differences in histopathological characteristics (pT/pN-stage, Gleason score, R-stage; all p>0.05) in both groups. Mean blood loss (276 ml vs. 937 ml), transfusion rate (0.9% vs. 8.7%) and 30-day complications according to the Clavien classification system (Clavien ≥ 2; 9.5% vs. 22.6%) were decreased in RARP (all p<0.05). In a multivariate logistic regression model, RARP vs. RRP was associated with a significantly reduced risk of a Clavien ≥ 2 complication during follow-up (OR 0.3; p= 0.0047). Recovery of continence was significantly better for RARP patients after 3 months (p= 0.02). There was no difference in erectile function 12 months postoperatively.

Conclusion

Our findings of decreased transfusion and complication rates and a trend of better early recovery of continence in RARP should be considered in obese patients (BMI >30) scheduled for radical prostatectomy.

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Literatur

  1. Ogden CL, Carroll MD, Kit BK et al (2012) Prevalence of obesity in the United States, 2009–2010. NCHS, Atlanta, pp 1–8

  2. Statistisches Bundesamt (2012) Gesundheitliche Lage – Körpergröße, Körpergewicht und Body-Mass-Index. In: Hagenkort-Rieger S (Hrsg) Statistisches Jahrbuch 2012 – Deutschland und Internationales. Statistisches Bundesamt, Wiesbaden, S 118

  3. Knoll K, Hauner H (2008) Kosten der Adipositas in der Bundesrepublik Deutschland-eine aktuelle Krankheitskostenstudie. Nuklearmedizin. Nucl Med 47:181–187

    Google Scholar 

  4. Van Roermund JG, Van Basten JP, Kiemeney LA et al (2009) Impact of obesity on surgical outcomes following open radical prostatectomy. Urol Int 82:256–261

    Article  Google Scholar 

  5. Bolenz C, Gupta A, Hotze T et al (2010) The influence of body mass index on the cost of radical prostatectomy for prostate cancer. BJU Int 106:1188–1193

    Article  PubMed  Google Scholar 

  6. Shabanzadeh DM, Sorensen LT (2012) Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg 256:934–945

    Article  PubMed  Google Scholar 

  7. Le CQ, Ho K-LV et al (2007) Peri-operative comparison between daVinci-assisted radical prostatectomy and open radical prostatectomy in obese patients. Society of Photo-Optical Instrumentation Engineers, ETATS-UNIS, Belligham

  8. Bae JJ, Choi SH, Kwon TG et al (2012) Advantages of robot-assisted laparoscopic radical prostatectomy in obese patients: comparison with the open procedure. Korean J Urol 53:536–540

    Article  PubMed Central  PubMed  Google Scholar 

  9. Ahlering TE, Eichel L, Edwards R et al (2005) Impact of obesity on clinical outcomes in robotic prostatectomy. Urology 65:740–744

    Article  PubMed  Google Scholar 

  10. Castle EP, Atug F, Woods M et al (2008) Impact of body mass index on outcomes after robot assisted radical prostatectomy. World J Urol 26:91–95

    Article  PubMed  Google Scholar 

  11. Wiltz AL, Shikanov S, Eggener SE et al (2009) Robotic radical prostatectomy in overweight and obese patients: oncological and validated-functional outcomes. Urology 73:316–322

    Article  PubMed  Google Scholar 

  12. Yates J, Munver R, Sawczuk I (2011) Robot-assisted laparoscopic radical prostatectomy in the morbidly obese patient. Prostate Cancer 2011:618623

    Article  PubMed Central  PubMed  Google Scholar 

  13. Clavien PA, Barkun J, De Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  14. WHO (2013) Obesity and overweight. In: World Health Organisation Fact sheet N311. World Health Organisation, Genf. http://www.who.int

  15. Budaus L, Isbarn H, Schlomm T et al (2009) Current technique of open intrafascial nerve-sparing retropubic prostatectomy. Eur Urol 56:317–324

    Article  PubMed  Google Scholar 

  16. Schlomm T, Heinzer H, Steuber T et al (2011) Full functional-length urethral sphincter preservation during radical prostatectomy. Eur Urol 60:320–329

    Article  PubMed  Google Scholar 

  17. Schlomm T, Tennstedt P, Huxhold C et al (2012) Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) increases nerve-sparing frequency and reduces positive surgical margins in open and robot-assisted laparoscopic radical prostatectomy: experience after 11,069 consecutive patients. Eur Urol 62:333–340

    Article  PubMed  Google Scholar 

  18. Beyer B, Schlomm T, Tennstedt P et al (2013) A feasible and time-efficient adaptation of NeuroSAFE for da Vinci robot-assisted radical prostatectomy. Eur Urol 66(1):138–144

    Article  PubMed  Google Scholar 

  19. Krukowski RA, West DS (2010) Consideration of the food environment in cancer risk reduction. J Am Diet Assoc 110:842–844

    Article  PubMed  Google Scholar 

  20. Pi-Sunyer FX (1993) Medical hazards of obesity. Ann Intern Med 119:655–660

    Article  CAS  PubMed  Google Scholar 

  21. Buschemeyer WC III, Freedland SJ (2007) Obesity and prostate cancer: epidemiology and clinical implications. Eur Urol 52:331–343

    Article  PubMed  Google Scholar 

  22. Allott EH, Masko EM, Freedland SJ (2012) Obesity and prostate cancer: weighing the evidence. Eur Urol 63(5):800–809

    Article  PubMed Central  PubMed  Google Scholar 

  23. Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65:124–137

    Article  PubMed  Google Scholar 

  24. Chang SS, Duong DT, Wells N et al (2004) Predicting blood loss and transfusion requirements during radical prostatectomy: the significant negative impact of increasing body mass index. J Urol 171:1861–1865

    Article  PubMed  Google Scholar 

  25. Mikhail AA, Stockton BR, Orvieto MA et al (2006) Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology 67:774–779

    Article  PubMed  Google Scholar 

  26. Loppenberg B, Noldus J, Holz A et al (2010) Reporting complications after open radical retropubic prostatectomy using the Martin criteria. J Urol 184:944–948

    Article  PubMed  Google Scholar 

  27. Tefekli A, Ali Karadag M, Tepeler K et al (2008) Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 53:184–190

    Article  PubMed  Google Scholar 

  28. Stolzenburg JU, Rabenalt R, Do M et al (2006) Categorisation of complications of endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy. World J Urol 24:88–93

    Article  PubMed  Google Scholar 

  29. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Beyer, K. Kühne, K. Böhm, J. Schiffmann, H. Heinzer, U. Michl, H. Huland, M. Graefen, A. Haese und T. Steuber geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Martini-Klinik Hamburg, Martinistraße 52, 20246, Hamburg, Deutschland

    B. Beyer, K. Kühne, K. Böhm, J. Schiffmann, H. Heinzer, U. Michl, H. Huland, M. Graefen, A. Haese &  T. Steuber

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  1. B. Beyer
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  2. K. Kühne
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  3. K. Böhm
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  5. H. Heinzer
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  6. U. Michl
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  7. H. Huland
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  8. M. Graefen
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  9. A. Haese
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  10. T. Steuber
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Correspondence to T. Steuber.

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Beyer, B., Kühne, K., Böhm, K. et al. Roboterassistierte radikale Prostatektomie. Urologe 54, 34–40 (2015). https://doi.org/10.1007/s00120-014-3589-y

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