Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

Impact of Obesity on Perioperative and Clinical Outcomes After Robotic Assisted Radical Prostatectomy

The aim of this study is to evaluate the effect of obesity on robotic-assisted radical prostatectomy (RARP) outcomes. This study included 120 obese patients [body mass index (BMI) ≥ 30 kg/m²] and 124 normal weight (BMI ≤ 25 kg/m²)] patients from a total of 750 patients who underwent RARP between January 2017 and March 2023. The perioperative and long-term oncological and functional outcomes were also analyzed. No significant differences were observed between the groups regarding age, prostate-specific antigen (PSA) levels, or International Society of Urological Pathology (ISUP) grade distribution (p > 0.05). The obese group had significantly longer median surgical times, vesicourethral anastomosis times, hospital stays and drain removal times compared to the control group (p < 0.05). The control group demonstrated significantly better continence recovery rate at the 1st month and erectile dysfunction (ED) recovery rate at the 12th month (p < 0.05). Bilateral nerve sparing (OR: 16.59; p < 0.001) and the preoperative IIEF score (OR: 1.29; p < 0.001) were identified as independent predictors of ED recovery in the multivariable logistic regression model. Bilateral nerve sparing (OR: 3.00; p < 0.001) and the absence of metabolic syndrome (OR: 2.03; p < 0.05) were found to be independent predictors of early continence recovery. There were no differences in systemic progression or overall survival at a median follow-up of 24 months (p > 0.05). While obesity adversely impacts perioperative outcomes, short-term continence recovery rates, and mid-term ED recovery rates, it does not affect mid-term oncological outcomes after RARP.

The Safety Assessment of Continuation of Perioperative Antiplatelet Therapy in Elective Robotic Surgery for Colorectal Cancer: A Retrospective Study

INTRODUCTION

Robotic surgery under condition of maintaining perioperative antiplatelet therapy (APT) is considered to have the risk of perioperative hemorrhagic events. We examined whether perioperative continuation of APT increased intraoperative blood loss and incidence of hemorrhagic complications in robot-assisted colorectal resection.

METHODS

The medical records of patients who underwent robotic surgical resection of colorectal cancer at our hospital between September 2020 and December 2023 were enrolled. Intraoperative blood loss, incidence of blood transfusion, and postoperative hemorrhagic complications were evaluated after dividing the study population into an APT group (patients receiving perioperative APT) and a non-APT group.

RESULTS

Twenty-seven patients were included in the APT group and 65 patients were the non-APT group. All patients in the APT group were continued aspirin monotherapy until the day before the surgery. There were more anticoagulated patients in the non-APT group than in the APT-group (27.7% vs. 7.4%, p = 0.0496). Median intraoperative blood loss in the APT and non-APT group were 14 and 15 mL, respectively (p = 0.802). The incidence of intraoperative blood transfusion and postoperative hemorrhagic complication in the respective group were 0% and 4.6% (p = 0.553) and 0% and 1.5% (p = 1.00).

CONCLUSION

The results of this study suggested that perioperative continuation of APT will be allowed in robot-assisted colorectal resection in terms of safety.

Perioperative Red Cell Line Trend following Robot-Assisted Radical Prostatectomy for Prostate Cancer

Background and Objective: Blood loss represents a long-standing concern of radical prostatectomy (RP). This study aimed to assess how red line cell values changed following robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa). Materials and Methods: The blood panels of 453 consecutive PCa patients undergoing RARP at a single tertiary academic referral center, from September 2020 to April 2022, were reviewed. Data from 363 patients with the blood panel available for the following timeframe: within seven days before surgery, six hours after surgery, and the first three postoperative days, were analyzed. Specifically, hemoglobin (Hb, g/dL), red blood cells (RBCs, ×106/μL), and hematocrit (HCT, %) trends were collected. Results: Considering the Hb trend, the median values in the preoperative day, postoperative day (POD) 2, and POD 3 are 14.7 (interquartile range (IQR) = 13.9−15.4), 12.1 (IQR = 11.2−12.9), and 12.2 (IQR = 11.2−13.1), respectively. The ∆ between preoperative day and POD 2 is 2.5 (IQR = 1.8−3.2) (p < 0.001). Considering the RBCs trend, the median values in the preoperative day, POD 2, and POD 3 are 4.9 (IQR = 4.7−5.3), 4.1 (IQR = 3.8−4.4), and 4.1 (IQR = 3.8−4.5), respectively. The ∆ between preoperative day and POD 2 is 0.9 (IQR = 0.6−1.1) (p < 0.001). Considering the HCT trend, the median values in the preoperative day, POD 2, and POD 3 are 44.4 (IQR = 41.7−46.6), 36.4 (IQR = 33.8−38.9), and 36.1 (IQR = 33.5−38.7), respectively. The ∆ between preoperative day and POD 2 is 7.8 (IQR = 5.2−10.5) (p < 0.001). Conclusions: Overall, patients undergoing RARP experience a significant, but clinically limited, decline in red line cell values between the preoperative time and the second day post-surgery. These observations are important to provide physicians with knowledge of the expected postoperative course and, thus, to improve the quality of patient care.

The 'prostate-muscle index': a simple pelvic cavity measurement predicting estimated blood loss and console time in robot-assisted radical prostatectomy

This study was to show the impact of ‘prostate-muscle index (PMI)’, which we developed as a novel pelvic cavity measurement, in patients undergoing robot-assisted radical prostatectomy (RARP). We defined PMI as the ‘distance between the inner edge of the obturator internus muscle and the lateral edge of the prostate at the magnetic resonance imaging (MRI) slice showing the maximum width of the prostate’. Seven hundred sixty patients underwent RARP at the University of Tokyo Hospital from November 2011 to December 2018. MRI results were unavailable in 111 patients. In total, 649 patients were eligible for this study. Median values of blood loss and console time were 300 mL and 168 min. In multivariate analysis, body mass index (BMI), prostate volume-to-pelvic cavity index (PV-to-PCI), PMI, and surgical experience were significantly associated with blood loss > 300 mL (P = 0.0002, 0.002, < 0.0001, and 0.006 respectively). Additionally, BMI, PMI, and surgical experience were also significantly associated with console time > 160 min in multivariate analysis (P = 0.04, 0.004, and < 0.0001, respectively). In conclusion, PMI may provide useful information to surgeons and patients in preoperative decision-making.