Analysis Of Correlated Factors Associated With Laparoscopic Radical Prostatectomy And Postoperative Recovery

Objective: The aim of this research is to investigate the risk factors of laparoscopic radical prostatectomy,furthermore,to analyze the factors associated with postoperative urinary continence and biochemical recurrence.Method: 56 patients who were confirmed prostate cancer by pathological results were enrolled in this study.All patients underwent the laparoscopic radical prostatectomy from January 2014 to December 2015 in The First Affiliated Hospital of Soochow University.These Patients’ clinical data were detailed studied in this retrospective research to find out the possible factors,including age,body mass index(BMI),preoperative PSA,Gleason score,prostate volume,operation time,intraoperative amount of bleeding,positive surgical margin,pathological TNM,membranous urethral length(MUL),prostatic urethral Angle(PUA).Urinary continence recovery data of patients were evaluated by urine pad count method in the 1,3,6,12 mouth follow-up.Collecting the biochemical recurrence data after 16~27 mouths.According to 2014 CUA Guidelines,the patients were divided into high-risk group and low-risk group by the preoperative PSA,Gleason and postoperative pathological TNM.All data were analyzed with SPSS20.0 statistical software,measurement data were compared by t-test,data comparison between the two groups were analyzed by chi-square test,the multi-factors Logistic analysis were used to evaluate the influence factors of intraoperative and postoperative condition.Results:(1)56 patients diagnosed prostate cancer by pathological results were enrolled in this study.The follow-up time was 16-27 months,and the mean time was 23 months.(2)The low-risk group had 17 patients(30.36%)with an average age of67.76±5.506 and the average BMI of 24.640±2.208kg/m2,as well as the high-risk group had 39 patients(69.64%)with an average age of 69.23±6.059 and the average BMI of24.233±4.339kg/m2.(3)There was no statistically significant difference in surgery and postoperative recovery between high-risk group and low-risk group patients.(4)PUA wasthe independent factor that affects the time of operation(OR=11.923,95%CI=3.161~44.967,p<0.001).There was also correlation between BMI and operation time,the time of BMI≥24kg/m2 group and BMI < 24kg/m2 group were 230.80±60.15 min and 196.23±56.39 min.The difference has statistical significance(p=0.032),but it was not the independent factors of operation time(p=0.281).(5)Patients with T4 had more blood loss than other patients(p=0.050).(6)Pathological TNM was the risk factor of positive surgical margin(p=0.024).(7)The MUL and PUA were the independent factors of the urinary continence recovery.MUL(OR=24.479,95%CI=4.527~111.609,p<0.001)and PUA(OR=4.204,95%CI=1.405~12.577,p=0.010)significantly reduced continence rate in1 month after the surgery.The MUL(OR=9.544,95%CI=1.726~52.888,p=0.010)reduced continence rate in 3 month as well,but the age(OR=0.150,95%CI=0.026~0.848,p=0.032)improve continence rate in 3 month.In this study,the continence rate in 6 mouth is only related to Pathological TNM(p<0.001).(8)The biochemical recurrence rate were 4.35%and 30.00% respectively in the pathological T2+T3a group and T3b+T4 group(p=0.049),which were identically preformed in the negative margin group and positive margin group(p=0.049).Conclusions: The study finds that PUA,BMI and the pathological stage of the patient are the correlated factors for difficulty and complexity of operation.The MUL,PUA,age and pathological stages affect the postoperative urination.The pathological stage and the margin are related to the biochemical recurrence.The larger the PUA,the shorter the time in the operation.Patients in BMI≥24kg/m2 group take more operation time than other patients.Patients with T4 have more blood loss than other patients.Positive surgical margin rate is improved with the increase of Pathological TNM.The MUL affects patients’ early postoperative urination,and the urinary control function of patients in MUL≥14mm group recover more quickly in 3 months.The larger the PUA,the better the urinary control recovery in 1 mouth,the associated factors of the urinary control function recovery is age in 3 mouth,and the patients with high pathological TNM result in a high rate of urinary incontinence.The postoperative biochemical recurrence rate is higher in patients with T3b+T4 pathological stages and positive margin.