Retrospective analysis on influencing factors of intraoperative indexes of robot-assisted laparoscopic radical prostatectomy / 第二军医大学学报

ABSTRACT

Objective To explore the influencing factors of operative time, blood loss and nerve-sparing of robotassisted laparoscopic radical prostatectomy (RALP). Methods A total of 184 patients with local or locally advanced prostate cancer were enrolled, and they underwent RALP by the single surgeon in Department of Urology of Changhai Hospital of Navy Medical University (Second Military Medical University) from January 1, 2016 to October 1, 2017. The effects of age, prostate volume, postoperative pathological Gleason score, pelvic lymph node dissection and biopsy approach on the operative time, blood loss and nerve-sparing of RALP were analyzed. The influencing factors of operative time and blood loss were analyzed by multivariate linear regression analysis. Linear correlation analysis was used to identify the correlation between operative time and prostate volume. LSD-t test was used to detect the difference of operative time among the patients with different lymph node dissections. The influencing factors of nerve-sparing during RALP were analyzed by multivariate logistic regression analysis. The difference of age was analyzed by one-way ANOVA and the differences of postoperative pathological Gleason score, lymph node dissection and biopsy approach were analyzed by Kruskal-Wallis H test between the patients with unreserved, reserved unilateral and reserved bilateral nerves. Results Multivariate linear regression analysis showed that prostate volume and lymph node dissection were independent influencing factors of RALP operative time (both P0.01). There was a significantly positive linear correlation between prostate volume and operative time (r＝0.201, P＝ 0.006). The patients with extended lymph node dissection had significantly longer operative time than those with obturator lymph node dissection, and the latter had significantly longer operative time than those without lymph node dissection (both P0.01). Age, prostate volume, postoperative pathological Gleason score, pelvic lymph node dissection, and biopsy approach had no significant effect on intraoperative blood loss (all P0.05). Multivariate logistic regression analysis showed that age, postoperative pathological Gleason score, lymph node dissection and biopsy approach were independent influencing factors of nerve-sparing during RALP (OR＝0.949, 95% CI 0.906-0.995, P＝0.027; OR＝0.742, 95% CI 0.551-0.999, P＝ 0.049; OR＝0.540, 95% CI 0.322-0.903, P＝0.019; OR＝0.457, 95% CI 0.230-0.905, P＝0.025). The cases with unreserved, reserved unilateral and reserved bilateral nerves were 108, 20 and 56, respectively; and the age, postoperative pathological Gleason score, lymph node dissection and biopsy approach were significantly different among the three groups (all P0.05). Conclusion The patients with prostate cancers, who have larger prostate volume or undergo lymph node dissection during RALP, may have longer operative time. Older age, higher postoperative pathological Gleason score, undergoing lymph node dissection or transrectal biopsy are not conductive to nerve-sparing during RALP.