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Purpose <p>To investigate intraoperative adverse events (IAEs) during robot-assisted radical prostatectomy using classification of intraoperative adverse events (ClassIntra) and their association with postoperative adverse events.</p> Patients and methods <p>This was a retrospective population-based cohort identified from an approved common database (Dai-CAD) for robot-assisted radical prostatectomy for prostate cancer at 25 Japanese institutions between 2011 and 2023. IAEs were graded according to ClassIntra. The association between IAEs and postoperative adverse events was examined using multivariate logistic regression analysis.</p> Result <p>Of the 8193 patients, 9 were excluded due to concurrent colon or rectal surgery concurrently (<i>n</i> = 6) and salvage surgery (<i>n</i> = 3), and the remaining 8184 patients were included in this study. Of the 8184 patients, 88 experienced ClassIntra grade ≥  2 IAEs. Among them, 50 patients (57%) experienced grade 2 IAEs, 32 (36%) experienced grade 3 IAEs, six patients (6.8%) experienced grade 4 IAEs, and no patients experienced grade 5 IAEs. Multivariate analysis revealed that ClassIntra grade   ≥   2 IAEs were independent risk factors for Clavien–Dindo grade ≥ 2 postoperative adverse events (odds ratio [OR] 2.62, 95% confidence interval [95%CI] 1.44–4.75, <i>p</i> = 0.002). Furthermore, ClassIntra grade   ≥  3 IAEs were independent risk factors for Clavien–Dindo grade  ≥  2 (OR 5.23, 95%CI 2.43–11.2, <i>p</i> &lt; 0.001) or ≥ 3 postoperative adverse events (OR 4.92, 95%CI 1.49–16.3, <i>p</i> = 0.009).</p> Conclusion <p>Evaluating IAEs according to ClassIntra is associated with postoperative adverse events and may support postoperative risk assessment according to the Clavien–Dindo classification.</p>

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Applying classification of intraoperative adverse events (ClassIntra) to robot-assisted radical prostatectomy to predict the risk of postoperative adverse events

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • Shinya Somiya,
  • Ryoichi Saito,
  • Toru Kanno,
  • Masashi Kubota,
  • Takayuki Sumiyoshi,
  • Masaaki Imamura,
  • Kyohei Sugiyama,
  • Masahiro Tamaki,
  • Tomohiro Fukui,
  • Hiroshi Iwamura,
  • Ryosuke Suzuki,
  • Kimihiro Shimatani,
  • Yuya Sekine,
  • Ryoma Kurahashi,
  • Atsuro Sawada,
  • Hiromitsu Negoro,
  • Shusuke Akamatsu,
  • Takayuki Goto,
  • Takashi Kobayashi,
  • Toshihide Hosomi,
  • Masafumi Tsuruta,
  • Naoki Hayata,
  • Mizuho Akahane,
  • Takashi Matsuoka,
  • Jin Kono,
  • Yuki Kita,
  • Yohei Abe,
  • Akihiko Nagoshi,
  • Tasuku Fujiwara,
  • Takanari Kambe,
  • Yuta Mine,
  • Hiroki Hagimoto,
  • Shiori Murata,
  • Yuto Hattori,
  • Hidetoshi Kokubun,
  • Naofumi Tsutsumi,
  • Toshinari Yamasaki,
  • Mutsushi Kawakita,
  • Naoto Takaoka,
  • Hiroki Watanabe,
  • Yurina Funahashi,
  • Maki Fujiwara,
  • Hiroaki Kawanishi,
  • Kazuhiro Okumura,
  • Masatoshi Kumagai,
  • Yusuke Shiraishi,
  • Masakatsu Ueda,
  • Koji Yoshimura,
  • Tomoya Okuno,
  • Takahiro Kirisawa,
  • Ayumu Matsuda,
  • Yoshiyuki Matsui,
  • Koji Inoue,
  • Atsushi Igarashi,
  • Hiromasa Araki,
  • Takayoshi Miura,
  • Yu Miyazaki,
  • Mutsuki Mishina,
  • Hiroshi Okuno,
  • Shinya Abe,
  • Kazuma Hiramatsu,
  • Noriyuki Makita,
  • Yuki Kamiyama,
  • Takehiko Segawa,
  • Yosuke Shimizu Sojun Kanamaru,
  • Tatsuya Hazama,
  • Yuta Yamada,
  • Toshifumi Takahashi,
  • Hideto Ota,
  • Masakazu Nakashima,
  • Noriyuki Ito,
  • Ken Maekawa,
  • Masakatsu Hirano,
  • Takehiro Takahashi,
  • Hiroyuki Onishi,
  • Kazunari Tsuchihashi,
  • Satoshi Ishitoya,
  • Shuhei Koike,
  • Ryosuke Ikeuchi,
  • Kosuke Nishizaki,
  • Takeshi Soda,
  • Takuya Okada,
  • Kodai Hattahara,
  • Koji Nishizawa,
  • Toru Yoshida,
  • Takaaki Takuma,
  • Kazuki Kokura,
  • Yuichi Uemura,
  • Jun Watanabe,
  • Daisuke Takahashi,
  • Kana Kohashiguchi,
  • Takeru Fujimoto,
  • Kosuke Ogawa,
  • Suguru Ito,
  • Yoshiyuki Okada,
  • Kazutoshi Okubo,
  • Naoki Kohei,
  • Shotaro Hatano,
  • Shuhei Goto,
  • Shigeki Fukuzawa,
  • Kanji Nagahama,
  • Toshiya Akao,
  • Rakuwakai Otowa,
  • Tomomi Kamba,
  • Motohiro Taguchi,
  • Shingo Yamamoto,
  • Atsushi Koizumi,
  • Tomonori Habuchi,
  • Hiroyuki Nishiyama,
  • Koji Yamasaki,
  • Toshiyuki Kamoto

摘要

Purpose

To investigate intraoperative adverse events (IAEs) during robot-assisted radical prostatectomy using classification of intraoperative adverse events (ClassIntra) and their association with postoperative adverse events.

Patients and methods

This was a retrospective population-based cohort identified from an approved common database (Dai-CAD) for robot-assisted radical prostatectomy for prostate cancer at 25 Japanese institutions between 2011 and 2023. IAEs were graded according to ClassIntra. The association between IAEs and postoperative adverse events was examined using multivariate logistic regression analysis.

Result

Of the 8193 patients, 9 were excluded due to concurrent colon or rectal surgery concurrently (n = 6) and salvage surgery (n = 3), and the remaining 8184 patients were included in this study. Of the 8184 patients, 88 experienced ClassIntra grade ≥  2 IAEs. Among them, 50 patients (57%) experienced grade 2 IAEs, 32 (36%) experienced grade 3 IAEs, six patients (6.8%) experienced grade 4 IAEs, and no patients experienced grade 5 IAEs. Multivariate analysis revealed that ClassIntra grade   ≥   2 IAEs were independent risk factors for Clavien–Dindo grade ≥ 2 postoperative adverse events (odds ratio [OR] 2.62, 95% confidence interval [95%CI] 1.44–4.75, p = 0.002). Furthermore, ClassIntra grade   ≥  3 IAEs were independent risk factors for Clavien–Dindo grade  ≥  2 (OR 5.23, 95%CI 2.43–11.2, p < 0.001) or ≥ 3 postoperative adverse events (OR 4.92, 95%CI 1.49–16.3, p = 0.009).

Conclusion

Evaluating IAEs according to ClassIntra is associated with postoperative adverse events and may support postoperative risk assessment according to the Clavien–Dindo classification.