Abstract

To evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

Highlights

  • Prostate cancer (PCa) is one of the most frequent tumors affecting aging males as well as challenging to treat

  • Operations were performed by surgeons who were classified into high and low volumes (> 100) according to a study reporting an initial reduction in complications and blood loss rate after 100 cases were performed [6]

  • The aim of this study is to investigate the association of several factors with the risk of blood transfusion, which included both intra- or post-operative blood transfusion events

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Summary

Introduction

Prostate cancer (PCa) is one of the most frequent tumors affecting aging males as well as challenging to treat. When life expectancy is above 10 years, guidelines recommend several treatment modalities for non-metastatic PCa, which include active surveillance, surgery and radiation therapy; multi-modality therapy is recommended when the disease is locally advanced [1, 2]. In urologic tertiary referral centers, robot-assisted radical prostatectomy (RARP) is the preferred surgical approach for prostate cancer [1, 2]. Robotic surgery has been shown to accelerate stress recovery post-operatively [3], and as with any laparoscopic approach, due to the insufflation of C­ O2, overcomes intraoperative severe bleeding which is one of. Journal of Robotic Surgery the most frequent major intraoperative complications of the open approach [4].

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