PDF(Pubmed)
Abstract：
Prostate cancer patients often have other health conditions and take anticoagulants. It was believed that surgery under anticoagulants could worsen surgical results. This study aims to explore the safety of robot-assisted prostatectomy in anticoagulated patients, without any exclusion criteria. The study included 500 patients who underwent RARP by a single surgeon between April 2019 and August 2022. Patients were divided into two groups: Group 1, consisting of 376 men (75.2%), did not receive any anticoagulation, while Group 2, with 124 patients (24.8%), received different forms of anticoagulation. Then, the anticoagulation group was divided into 4 subgroups according to their definite anticoagulation: the aspirin 15.6%, new oral anticoagulants (NOAC) 5.4%, Vitamin K antagonist (VKA) 2%, and dual-antiplatelet therapy (DAPT) 1.8% subgroup. Postoperative complications and readmission rates were compared between the two study groups and subgroups. Patients in the combined group 2 were older and they also carried more comorbidities compared to men in group 1 (p = 0.03, p = 0.001).The study groups had similar oncological results, with 40.4% of patients having locally advanced cancers. Catheter days were longer in the anticoagulation group (4.5 vs 4 days, p = 0.001). No significant differences were observed between study groups for overall, minor, and major complications (p = 0.160, 0.100, and 0.915, respectively). In addition, readmissions were low (5.6%) and similar between the study groups (p = 0.635). Under cautious management, RARP under diverse anticoagulation regimes is safe and has comparable results to men with no medications. Further prospective studies must be conducted to confirm our findings.
摘要：
前列腺癌患者通常有其他健康状况并服用抗凝剂。据认为，抗凝剂下的手术可能会使手术结果恶化。本研究旨在探讨机器人辅助前列腺切除术在抗凝患者中的安全性,没有任何排除标准。该研究包括500名患者，他们在2019年4月至2022年8月期间接受了一名外科医生的RARP。患者分为两组：第1组，由376名男性（75.2％）组成，没有接受任何抗凝治疗，而第二组，有124名患者(24.8%)，接受不同形式的抗凝治疗。然后，抗凝组根据其明确的抗凝作用分为4个亚组:阿司匹林15.6%,新口服抗凝剂（NOAC）5.4％，维生素K拮抗剂（VKA）2%，和双重抗血小板治疗(DAPT)1.8%亚组。比较两个研究组和亚组的术后并发症和再入院率。与第1组的男性相比，第2组的患者年龄更大，并且合并症也更多（p=0.03，p=0.001）。研究组有相似的肿瘤结果，40.4%的患者患有局部晚期癌症。抗凝组的导管天数更长（4.5天vs4天，p=0.001)。总体上，研究组之间没有观察到显著差异。未成年人,和主要并发症（分别为p=0.160、0.100和0.915）。此外,再入院率较低(5.6%),研究组间相似(p=0.635).在谨慎的管理下，RARP在多种抗凝方案下是安全的，并且与没有药物的男性具有可比的结果。必须进行进一步的前瞻性研究以证实我们的发现。
