Incidence and Risk Factors of Pulmonary Complications after Robot-Assisted Laparoscopic Prostatectomy: A Retrospective Observational Analysis of 2208 Patients at a Large Single Center.

Kim Kim,Park Park,Hwang Hwang,Yu Yu,Seo Seo

doi:10.3390/jcm8101509

Abstract

Robot-assisted laparoscopic prostatectomy (RALP) is a minimally invasive technique for the treatment of prostate cancer. RALP requires the patient to be placed in the steep Trendelenburg position, along with pneumoperitoneum, which may increase the risk of postoperative pulmonary complications (PPCs). This large single-center retrospective study evaluated the incidence and risk factors of PPCs in 2208 patients who underwent RALP between 2014 and 2017. Patients were divided into those with (PPC group) and without (non-PPC group) PPCs. Postoperative outcomes were evaluated, and univariate and multivariate logistic regression analyses were performed to assess risk factors of PPCs. PPCs occurred in 682 patients (30.9%). Risk factors of PPCs included age (odds ratio [OR], 1.023; p = 0.001), body mass index (OR, 1.061; p = 0.001), hypoalbuminemia (OR, 1.653; p = 0.008), and positive end-expiratory pressure (PEEP) application (OR, 0.283; p < 0.001). The incidence of postoperative complications, rate of intensive care unit (ICU) admission, and duration of ICU stay were significantly greater in the PPC group than in the non-PPC group. In conclusion, the incidence of PPCs in patients who underwent RALP under pneumoperitoneum in the steep Trendelenburg position was 30.9%. Factors associated with PPCs included older age, higher body mass index, hypoalbuminemia, and lack of PEEP.

Highlights

Robot-assisted laparoscopic prostatectomy (RALP) has several advantages over open prostatectomy in patients with prostate cancer, including lower perioperative bleeding risk, shorter operating time, and shorter hospital stay [1,2]
Multivariate logistic regression analysis found that older age, higher body mass index, hypoalbuminemia, and lack of positive end-expiratory pressure (PEEP) were significantly associated with pulmonary complications (PPCs)
In agreement with previous results [5,37,50], the present study found that the rate of intensive care unit (ICU) admission and the length of ICU stay were significantly greater in prostate cancer patients with than without PPCs [5,37,50]

Summary

Introduction

Robot-assisted laparoscopic prostatectomy (RALP) has several advantages over open prostatectomy in patients with prostate cancer, including lower perioperative bleeding risk, shorter operating time, and shorter hospital stay [1,2]. RALP, has a detrimental effect on the respiratory system due to the effects of carbon dioxide pneumoperitoneum and placement of the patient in the steep Trendelenburg position. These specific conditions can lead to reductions in lung volume, functional residual capacity and vital capacity; a decrease of lung compliance; a deterioration in ventilation–perfusion mismatch; and an increase in peak airway pressure [3,4]. Carbon dioxide pneumoperitoneum can cause hypercarbia and respiratory acidosis These undesirable effects on the respiratory system from these particular surgical conditions may lead to postoperative pulmonary complications (PPCs) in patients undergoing RALP. To date, little information is available regarding PPCs in patients undergoing RALP

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