This paper reevaluates the recently reported excess mortality following transurethral resection of the prostate (TURP) for benign hypertrophy as compared with traditional open resection (OPEN). We studied survival through linkage of hospital discharge data with mortality data for the entire male population of Denmark (1977-85). For a maximum of 10.5 years 38,067 prostatectomy patients were followed. Adjusting for age and health status before surgery, TURP patients were subject to significantly higher levels of mortality than OPEN patients (RR = 1.19, 95% confidence interval (1.15-1.24). The extent to which this difference is attributable to the surgical intervention itself remains an open question. The two groups of patients are quite different with regard to age and preoperative health status, and available data may not be sufficient to control such differences through statistical analysis. On the other hand, the difference in mortality persisted over calendar time, even during periods when the pattern of utilization for the two procedures changed significantly (constant RR = 1.19, adjusting for age and comorbidity). The most important causes of death among Danish TURP patients differ from the causes suggested on the basis of previously reported Canadian data. The current evidence is thus ambiguous with regard to hypothetical biologic mechanisms behind the excess mortality over TURP patients. Further investigations are needed to evaluate the safety and effectiveness of prostate surgery.

译文

:本文重新评估了最近报道的与传统的开放性切除术(OPEN)相比,经尿道前列腺良性肥大手术(TURP)后的额外死亡率。我们通过将出院数据与丹麦整个男性人口(1977-85年)的死亡率数据相联系来研究生存率。在长达10.5年的时间里,对38,067例前列腺切除术患者进行了随访。调整手术前的年龄和健康状况后,TURP患者的死亡率要比OPEN患者高得多(RR = 1.19,95%置信区间(1.15-1.24)。两组患者在年龄和术前健康状况方面都存在很大差异,可用的数据可能不足以通过统计分析来控制这种差异;另一方面,死亡率的差异在整个日历时间内仍然存在,即使在这两种方法的使用方式发生显着变化的时期(恒定RR = 1.19,已根据年龄和合并症进行了调整),丹麦TURP患者中最重要的死亡原因也不同于先前报道的加拿大所建议的原因。因此,目前的证据对于超过T的超额死亡率背后的假设生物学机制尚不明确。 URP患者。需要进一步的研究以评估前列腺手术的安全性和有效性。

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