Acute kidney injury and its impact on renal prognosis after robot‐assisted laparoscopic radical prostatectomy

Abstract

Background: This study assessed the incidence and impact of acute kidney injury (AKI) on renal prognosis in patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP). Methods: Medical records of 305 patients treated with RARP were retrospectively reviewed. The patients with postoperative AKIs were dichotomized into early AKI (immediately after surgery) and late AKI (1-7 days after surgery). The impact of AKIs and their risk factors were statistically assessed. Results: Early and late AKI were observed in 143 (46.9%) and 12 (3.9%) patients, respectively. Hypertension and console time were independent risk factors for early AKI. Among the patients with preoperative eGFR ≥60 mL/min, the eGFR decline 12 months after surgery was significantly greater in patients with early AKI than that without early AKI (−6.8 vs −3.2 mL/min, P = .02). Conclusions: Approximately half of patients developed early AKI after RARP. The patients with early AKI had reduced renal function 12 months after surgery. K E Y W O R D S acute kidney injury, prostate cancer, robot-assisted laparoscopic radical prostatectomy 1 | INTRODUCTION Prostate cancer is the second leading cause of cancer-related death in men worldwide. 1 Radical prostatectomy is one of the standard modalities for localized prostate cancer. 2 Robotic surgery has been accepted to improve surgical quality 3 in urological surgery, and robot-assisted laparoscopic radical prostatectomy (RARP) has become one of the most widely used procedures due to its minimal invasiveness and comparable outcomes with conventional procedures. 4,5 Therefore, it is important to achieve satisfactory surgical outcomes of RARP without peri-and postoperative complications. Acute kidney injury (AKI) is a postoperative complication of prostatectomy that is associated with chronic kidney disease (CKD) and death. 6,7 There are several potential causes of postoperative AKI, including patient and surgical factors. 7 RARP can impair renal function due to high pneumoperitoneum pressure and an extremely steep head-down position of the patient. 8,9 Several studies report the incidence of AKI after RARP compared with that after conventional open surgery. 7,10 However, the frequency and clinical significance of AKI after RARP remains unclear. In this study, we assessed the incidence, risk factors and impact on renal prognosis of AKI observed during the very early period after surgery in patients with prostate cancer who underwent RARP. 2 | PATIENTS AND METHODS 2.1 | Patients and study design We retrospectively reviewed the medical records of 305 consecutive patients with localized prostate cancer patients who underwent

Intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy: a retrospective study

“…There are some studies stating that there is no association between intraoperative urine output and the occurrence of AKI 30 , 31 , while others are advocating for the association between oliguria and the occurrence of AKI after major non-cardiac surgery 28 , 32 , 33 . Although some previous studies investigated the risk factors for AKI after RALP, none of those included the urine output as a candidate variable 6 – 8 . Therefore, our study is the first to identify the low intraoperative urine output as a risk factor for AKI in RALP.…”

“…The AKI incidence in our study was 2.4%, which is half of the previously reported incidence (5%) in RALP 5 , 6 . Some studies have demonstrated that a longer operation time represents a risk factor for AKI after RALP 6 – 8 . Therefore, our low AKI incidence could be attributed to shorter operation times than those observed in previous studies in which the mean operation time was around 170–180 min 6 .…”

“…The incidence of acute kidney injury (AKI) after RALP has been reported to be significantly lower than that after open radical prostatectomy 5 ; however, AKI still occurs in approximately 5% of patients undergoing RALP 5 , 6 . Moreover, an acute increase in serum creatinine (SCr) levels after RALP usually occurs on the operation day 7 , 8 . Patients who develop AKI on the operation day have been reported to present reduced renal function at 12 months after RALP 8 .…”

“…Moreover, an acute increase in serum creatinine (SCr) levels after RALP usually occurs on the operation day 7 , 8 . Patients who develop AKI on the operation day have been reported to present reduced renal function at 12 months after RALP 8 . Therefore, careful perioperative management may be crucial for preventing AKI.…”

“…Therefore, abrupt changes in MAP during RALP can affect postoperative kidney function. Moreover, patients undergoing RALP are mostly older adults with various comorbidities, including hypertension and diabetes mellitus 5 , 6 , 8 , 12 , which may further increase BP variability and the intraoperative risk of hypotension 13 , 18 . However, the relationship between intraoperative MAP changes and postoperative AKI in patients undergoing RALP remains unclear.…”