Application of the method based on segmented operative time in analysis of RALP difficulty factors
ZHANG Chunlei1,2, CHEN Rui1, GAO Xu1
1Department of Urology, Shanghai Changhai Hospital, Naval Military Medical University, Shanghai 200433, China; 2Department of Urology, the 940th Hospital of Joint Logistics Support Force of Chinese PLA
Abstract：Objective： To evaluate whether the interval from prostate biopsy to radical prostatectomy （Interval） affects the difficulty of each step of robot-assisted laparoscopic radical prostatectomy （RALP）, and verify the feasibility of the method based on segmented operative time to criticize the influencing factors of the difficulty of RALP. Methods： A total of 209 patients with localized and locally advanced prostate cancer who underwent RALP by a single surgeon with experience from January 2016 to September 2017 in Shanghai Changhai Hospital were enrolled. The operative time was divided into 7 periods by 8 relatively stable checkpoints based on prospectively recorded surgical videos. Interval was categorized as ≤3 weeks, 3 to 6 weeks, 6 to 9 weeks, and >9 weeks. The differences in clinicopathological characteristics categorized by Interval were analyzed by Kruskal-Wallis H test and Chi-square test. Multivariate linear regression was applied to analyze the independent influencing factors of total and each step operative time. Results： No significant difference in operative time of total and each step among groups stratified by Interval was detected. Larger prostate volume （P = 0.005） and lymph node dissection （P = 0.001） were independent predictors of longer total operative time. Age, body mass index, preoperative PSA, prostate volume, pathological Gleason score, lymph node dissection, and nerve-sparing had effects on each corresponding step. The effect of Interval on operation time had no clinical significance. Conclusion： The method based on segmented operative time is an effective and viable way to criticize the influencing factors of the difficulty of RALP. For an experienced surgeon, RALP may be performed before the traditionally recommended Interval of 6 to 8 weeks in terms of operative time only. However, these results should be taken with great caution. Further studies involving multiple surgeons, intraoperative complications, and postoperative outcomes are warranted to validate these findings.
张春雷, 陈锐, 高旭. 手术时间分段分析法在机器人辅助腹腔镜前列腺癌根治性切除术难度因素分析中的应用[J]. 微创泌尿外科杂志, 2021, 10(3): 152-156.
ZHANG Chunlei, CHEN Rui, GAO Xu. Application of the method based on segmented operative time in analysis of RALP difficulty factors. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(3): 152-156.
[1] SIEGEL RL, MILLER KD, JEMAL A. Cancer Statistics, 2020. CA Cancer J Clin, 2020,70(1):7-30. [2] WEIN AJ. Campbell-Walsh Urology, 11th ed. Philadelphia: Elsevier, 2016:435. [3] JO JK, OH JJ, LEE S, et al.Can robot-assisted laparoscopic radical prostatectomy (RALP) be performed very soon after biopsy? World J Urol, 2017,35(4):605-612. [4] LI J, JIANG Q, LI Q, et al.Does time interval between prostate biopsy and surgery affect outcomes of radical prostatectomy? A systematic review and meta-analysis. Int Urol Nephrol, 2020,52(4):619-631. [5] KANEKO G, MIYAJIMA A, YAZAWA S, et al.What is the predictor of prolonged operative time during laparoscopic radical prostatectomy? Int J Urol, 2013,20(3):330-336. [6] CHANG Y, QU M, WANG L, et al.Robotic-assisted Laparoscopic Radical Prostatectomy From a Single Chinese Center: A Learning Curve Analysis. Urology, 2016,93:104-111. [7] PATEL VR. Robotic Urologic Surgery, 1st ed. London: Springer, 2007:125. [8] MOTTET N, CORNFORD P, VAN DEN BERGH RN, et al.EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer—2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol, 2021,79(2):243-262. [9] EPSTEIN JI, AMIN MB, REUTER VE, et al.Contemporary Gleason grading of prostatic carcinoma: an update with discussion on practical issues to implement the 2014 international society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol, 2017,41(4):e1-e7. [10] LABANARIS AP, ZUGOR V, WITT JH.Robot-assisted radical prostatectomy in patients with a pathologic prostate specimen weight ≥100 grams versus ≤50 grams: surgical, oncologic and short-term functional outcomes. Urol Int, 2013,90(1):24-30. [11] BOORJIAN SA, CRISPEN PL, CARLSON RE, et al.Impact of obesity on clinicopathologic outcomes after robot-assisted laparoscopic prostatectomy. J Endourol, 2008,22(7):1471-1476. [12] 张春雷,陈锐,杨琦,等.单一术者机器人辅助腹腔镜前列腺癌根治术术中指标影响因素分析.第二军医大学学报,2018,39(4):366-371. [13] CORIC J, MUJIC J, KUCUKALIC E, et al.Prostate-Specific antigen (PSA) and prostate volume: better predictor of prostate cancer for bosnian and herzegovina men. Open Biochem J, 2015,9(1):34-36. [14] KARADEMIR I, SHEN D, PENG Y, et al.Prostate volumes derived from MRI and volume-adjusted serum prostate-specific antigen: correlation with Gleason score of prostate cancer. AJR Am J Roentgenol, 2013,201(5):1041-1048. [15] NOURELDIN ME, CONNOR MJ, BOXALL N, et al.Current techniques of prostate biopsy: an update from past to present. Transl Androl Urol, 2020,9(3):1510-1517. [16] WADHWA K, PATRUNO G, PATTERSON A, et al.Robotic assisted laparoscopic radical prostatectomy following transrectal compared to transperineal prostate biopsy: surgical, oncological and functional outcomes. Minerva Urol Nefrol, 2017,69(1):85-92. [17] MOHAMMED W, DAVIS NF, ELAMIN S, et al.Six-core versus twelve-core prostate biopsy: a retrospective study comparing accuracy, oncological outcomes and safety. Ir J Med Sci, 2016,185(1):219-223. [18] CHOI H, KO YH, KANG SG, et al.Biopsy related prostate status does not affect the clinicopathological outcome of robotic assisted laparoscopic radical prostatectomy. Cancer Res Treat, 2009,41(4):205-210.
