Blood loss during radical prostatectomy: impact on clinical, oncological and functional outcomes and complication rates

Djavan, Bob; Agalliu, Ilir; Laze, Juliana; Sadri, Helen; Kazzazi, Amir; Lepor, Herbert

doi:10.1111/j.1464-410x.2011.10812.x

Cited by 20 publications

(13 citation statements)

References 24 publications

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“…Despite the introduction of laparoscopy (including robotic-assisted approaches), open radical retropubic prostatectomy is still the standard surgical treatment for localized prostate cancer (4, 7-11). The historical gold standard of transurethral resection of prostate (TURP), which is an effective procedure, is still associated with the risk of intraoperative and postoperative bleeding (2, 12-14). …”

Section: Introductionmentioning

confidence: 99%

Local Administration of Tranexamic Acid During Prostatectomy Surgery: Effects on Reducing the Amount of Bleeding

et al. 2016

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BackgroundOne of the issues in prostatectomy surgery is bleeding. Although tranexamic acid (TRA) is an antifibrinolytic agent for reducing bleeding, controversies surround its use.ObjectivesIn this study, the effect of local administration of TRA on reducing bleeding during prostatectomy surgery was evaluated.MethodsA total of 186 patients who underwent prostatectomy surgery were assessed in this clinical trial study. Patients were divided randomly into two groups. After prostate removal, TRA (500 mg TRA with 5 mL total volume) to the intervention group and normal saline to the control group were sprayed with the same volume. At the end of surgery, the prescribed blood bags were measured and recorded. Hemoglobin and platelet levels were recorded 6 hours after the test. Moreover, the amounts of blood inside the blood bags in the first 24 hours, the second 24 hours, and the total length of hospital stay were recorded and compared in each group.ResultsBy comparing the measured values before and after surgery, we found that the amounts of hemoglobin, hematocrit, and platelet decreased. The mean blood loss in the intervention group was recorded at 340 mL and that in the control group was 515 mL. The maximum bleeding in the control group was almost twice as much as that in the intervention group. Blood loss in the intervention group with the administration of TRA was significantly lesser than that in the control group (P = 0.01). The decrease in platelet level in the intervention group was significantly lower than that in the control group (P = 0.03).ConclusionsThe present study showed that local administration of TRA significantly reduces bleeding after prostatectomy surgery and is effective in preventing postoperative hemoglobin decrease.

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Section: Introductionmentioning

confidence: 99%

Local Administration of Tranexamic Acid During Prostatectomy Surgery: Effects on Reducing the Amount of Bleeding

et al. 2016

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“…In RP, dissection of the posterior surface of the prostate is performed at the layer between the rectum and DF, and the prostate is removed with DF [15]. In our study at the midpoint of the prostate posterior, the DF fused with the PC in 94 % of the case.…”

Section: Discussionmentioning

confidence: 66%

“…The RP (open surgery, laparoscopy or robotic-assisted procedures) allows the dissection and identification of the different fasciae surrounding the prostate and the preservation of the neurovascular bundles [15]. However, fascial dissection remains conditioned by oncologic radicality, tumor location, size and Gleason score.…”

Section: Resultsmentioning

confidence: 99%

Role of transrectal ultrasound in the diagnosis of extracapsular prostate cancer

Dell’Atti

2014

J Ultrasound

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In our opinion, it is very important to recognize preoperatively the possibility of cancer extracapsular extension to the DF and to the rectum wall, using a simple and low cost examination as TRUS. The knowledge of the fascial structures anatomy around the prostate is necessary to perform a nerve-sparing radical prostatectomy, avoiding excessive bleeding, iatrogenic positive surgical margin, and post-operative complications.

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“…Many studies comparing RALP with retropubic radical prostatectomy have found that RALP reduces blood loss during surgery [3, 6–8]. Typical blood loss during RALP at our institution is less than 300 mL, including that passed through the urine.…”

Section: Discussionmentioning

confidence: 96%

Unexpected hemorrhage during robot-assisted laparoscopic prostatectomy: a case report

et al. 2016

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BackgroundRobot-assisted laparoscopic prostatectomy is increasingly performed as a minimally invasive option for patients with organ-confined prostate cancer. This technique offers several advantages over other surgical methods. However, concerns have been raised over the effects of the steep head-down tilt necessary during the procedure. We present a case in which head-down positioning and abdominal insufflation masked the signs of an intraoperative hemorrhage.Case presentationA 73-year-old Asian man developed severe hypotension caused by an unexpected hemorrhage during robot-assisted laparoscopic prostatectomy for prostate cancer. Although our patient’s blood pressure steadily decreased during the procedure, his systolic blood pressure remained above 80 mmHg while he was tilted head downward at an angle of 28°. However, his blood pressure dropped immediately after he was returned to the horizontal position and abdominal insufflation – to create a pneumoperitoneum – was ceased at the end of surgery. We returned the patient to a head-down tilt to keep his blood pressure stable and began fluid infusion. Blood test results indicated that a hemorrhage was the cause of his hypotension. Open abdominal surgery was performed to stop the bleeding. The surgeons found blood pooling inside his abdomen from a longitudinal cut in a small arterial vessel in his abdominal wall, possibly a branch of his external iliac artery. The surgeons successfully controlled the hemorrhage and our patient was moved to our intensive care unit. Our patient recovered completely over the next few days, without any neurological deficits.ConclusionsWe suspect that blood began to pool in our patient’s superior abdomen during surgery, and that increased intra-abdominal pressure suppressed the hemorrhage. When our patient was returned to the horizontal position and insufflation of his abdomen was discontinued, the resulting increased rate of hemorrhage caused a sudden drop in blood pressure. Surgeons and anesthesiologists must understand the hemodynamic changes that result from head-down patient positioning and abdominal insufflation.

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Blood loss during radical prostatectomy: impact on clinical, oncological and functional outcomes and complication rates

Cited by 20 publications

References 24 publications

Local Administration of Tranexamic Acid During Prostatectomy Surgery: Effects on Reducing the Amount of Bleeding

Local Administration of Tranexamic Acid During Prostatectomy Surgery: Effects on Reducing the Amount of Bleeding

Role of transrectal ultrasound in the diagnosis of extracapsular prostate cancer

Unexpected hemorrhage during robot-assisted laparoscopic prostatectomy: a case report

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