Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press58910.17650/1726-9776-2016-12-4-60-69DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. PROSTATE CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак предстательной железыEarly recovery program in the radical surgical treatment of patients with prostate cancer: experience of the specialized hospitalПрограмма раннего восстановления при радикальном хирургическом лечении больных раком предстательной железы: опыт специализированного стационараNosovA. K.НосовА К.
Russian Federation

68 Leningradskaya St., Pesochnyy, Saint Peterburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

nakuro@yandex.ruRevaS. A.РеваС. А.

68 Leningradskaya St., Pesochnyy, Saint Peterburg 197758,

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

sgreva79@mail.ruBerkutM. V.БеркутМ. В.
Russian Federation

68 Leningradskaya St., Pesochnyy, Saint Peterburg 197758,

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

berkut_91@mail.ruPetrovS. B.ПетровС. Б.

68 Leningradskaya St., Pesochnyy, Saint Peterburg 197758,

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

petrov-uro@yandex.ruN.N. Petrov Reseach Institute of Oncology, Ministry of Health of RussiaФГБУ «Научно-исследовательский институт онкологии им. Н.Н. Петрова» Минздрава России3012201612460692007201606102016https://oncourology.abvpress.ru/oncur/article/view/589

Background. Currently, there are sufficient data on the favorable role of fast track program on the course of postoperative period. Nevertheless, the role of these protocols being already included in the standards of the surgical treatment of many cancers is not clear to date in oncourology in general and in the prostate cancer (PC).

Objective: to determine the effect of fast track program elements for the results of treatment in patients after radical prostatectomy.

Materials and methods. 86 radical minimally invasive (laparoscopic or endoscopic extraperitoneal) prostatectomies were performed for prostate cancer in the period from May 2015 to February 2016 in the Oncological Research Institute named after N.N. Petrov. Patients were divided into 2 groups: in patients of the 1st (n = 44) group included those with traditional surgical management fast track elements were not used at all or were used partly; in the 2nd group (n = 42) these elements were used in a whole volume. We have assessed an influence of fast track elements on the frequency of perioperative and early postoperative complications, operative time, duration of the hospitalization and duration of the stay in intensive care unit, frequency of the repeated surgical interventions, and frequency of the repeated hospitalizations within 30 days of the postoperative period.

Results. The presence and the absence of preoperative preparation did not affect an incidence of intraoperative complications. Intraoperative blood loss did not lead to blood transfusions. There were no significant differences in the incidence of 30-day complications between groups. When evaluating postoperative parameters there was difference between 1st and 2nd groups in the pelvis drainage (3.3 and 0.9 days, respectively, p = 0.002), an average duration of catheterization (11.2 and 5.2 days, respectively, p = 0.0003) and duration of hospitalization (15.1 and 6.5 days, respectively, p = 0.0008).

Conclusion. Application of fast track program of perioperative management of patients with prostate cancer does not affect the frequency of intraand postoperative complications, but economically it is potentially more feasible, primarily by reducing the term of the patient stay in hospital.

Введение. В настоящее время существует достаточно данных о благоприятной роли программы раннего восстановления (fast track) на течение послеоперационного периода. Тем не менее роль этих протоколов, уже включенных в стандарты при хирургическом лечении многих онкологических заболеваний, на сегодняшний день в онкоурологии в целом и при раке предстательной железы (РПЖ) в частности не ясна.

Цель исследования – определить влияние элементов программы fast track на результаты лечения у пациентов после радикальной простатэктомии.

Материалы и методы. В период с мая 2015 г. по февраль 2016 г. в НИИ онкологии им. Н.Н. Петрова проведено 86 радикальных минимально инвазивных (лапароскопических или внебрюшинных эндоскопических) простатэктомий по поводу РПЖ. Больные были разделены на 2 группы: в 1-й группе (n = 44) традиционного хирургического ведения элементы fast track не применяли совсем или использовали частично; во 2-й (n = 42) – в полном объеме. Оценивали влияние выполнения положений fast track на частоту интраоперационных и ранних послеоперационных осложнений, длительность операции, сроки госпитализации и нахождения в отделе- нии реанимации и интенсивной терапии, частоту повторных хирургических вмешательств, а также повторных госпитализаций в течение 30 дней послеоперационного периода.

Результаты. Наличие и отсутствие предоперационной подготовки не повлияли на частоту развития интраоперационных осложнений. Интраоперационная кровопотеря не привела к необходимости выполнения гемотрансфузий. Достоверных различий в частоте развития 30-дневных осложнений между группами не наблюдали. При оценке послеоперационных показателей отмечена разница между 1-й и 2-й группами в длительности дренирования таза (3,3 и 0,9 сут соответственно, p = 0,002), средней дли- тельности катетеризации (11,2 и 5,2 сут соответственно, p = 0,0003) и длительности госпитализации (15,1 и 6,5 сут соответственно, p = 0,0008).

Заключение. Применение принципов ускоренной программы периоперационного ведения пациентов (fast track) при лечении больных РПЖ не влияет на частоту интра- и послеоперационных осложнений, однако потенциально экономически более целесообразно прежде всего за счет уменьшения срока нахождения больного в стационаре.

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