肌少症與機械手臂輔助攝護腺切除手術預後之探討

江長和1、黃子豪^1,2、張延驊^1,2、鍾孝仁^1,2、黃逸修^1,2、

林子平^1,2、林志杰^1,2、黃奕燊^1,2、魏子鈞^1,2、陳威任^1,2、黃志賢^1,2

¹臺北榮民總醫院泌尿部

²國立陽明交通大學醫學院泌尿學科 書田泌尿科學研究中心

The association between sarcopenia and postoperative outcomes after robotic assisted radical prostatectomy

Chang-Ho Chiang¹, Tzu-Hao Huang^1,2, Yen-Hwa Chang^1,2,

Hsiao-Jen Chung^1,2,Eric Yi-Hsiu Huang^1,2, Tzu-Ping Lin^1,2,Chih-Chieh Lin ^1,2,

I-Shen Huang^1,2, Tzu-Chun Wei^1,2,Wei-Jen Chen^1,2,William J. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital,

²Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Sarcopenia is known to affect perioperative outcomes in patients with different malignancies, but knowledge about the significance of sarcopenia in prostate cancer (PCa) patients is limited. This study aimed to evaluate the association between radiologically defined sarcopenia and postoperative outcomes for patients undergoing robotic assisted radical prostatectomy (RALP).

Materials and Methods:

From January 2016 to December 2019, total 511 patients underwent RALP at Taipei Veterans General Hospital. Among them, 303 patients who had available qualified MRI at L3 level to calculate skeletal muscle mass index (SMI) were enrolled. The 5th percentile of SMI was defined as the cutoff value of sarcopenia in our population.  Demographic data and various perioperative factors were included in our analyses. The outcomes of interest were the association between sarcopenia and postoperative outcomes after RALP. We further defined a “high-volume surgeon” as who performed more than 15 cases of RALP annually.

Results

The cutoff value of sarcopenia in our study is 40cm²/m², which correspond to the 5th percentile of SMI in our population. Of 303 enrolled patients, 18 had sarcopenia and 285 did not. In our cohort, sarcopenia was associated with higher incidence of overall and clinically significant vesicourethral anastomosis (VUA) leakage and longer Foley indwelling time.

On multivariant analysis, sarcopenia was significantly associated with clinically significant leakage (OR=4.736, 95% CI: 1.269-17.666, p=0.021), delayed Foley removal (OR=5.612, 95% CI: 1.589-19.818, p=0.007), overall complications (OR=3.578, 95% CI: 1.159-11.044, p=0.027). These correlation remained significant on sensitivity analysis, which examined surgeries conducted by high-volume surgeons.

Conclusions

Our study highlights the prognostic value of sarcopenia in patients after RALP about VUA leakage, delayed Foley removal and overall complication. On top of that, measurement of skeletal muscle on preoperative MRI at the L3 vertebral level represents a quick and easy method for defining sarcopenia. The increased risk of anastomosis leakage, which may hinder Foley removal, along with the higher overall complication rate, should be more emphasized for PCa patients with sarcopenia.