Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy

Abstract

Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion. The objective of this study was to compare the incidence of postoperative AKI between RRP and RALP.We included 1340 patients who underwent RRP (n = 370) or RALP (n = 970) between 2013 and 2014. Demographics, cancer-related data, and perioperative laboratory data were evaluated. Postoperative AKI was determined according to the Kidney Disease: Improving Global Outcomes criteria. Operation and anesthesia time, estimated blood loss, amounts of administered fluids and transfused packed red blood cells, and the lengths of the postoperative intensive care unit and hospital stays were evaluated. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences between the RRP and RALP groups.After performing 1:1 propensity score matching, the RRP and RALP groups included 307 patients, respectively. The operation time and anesthesia time in RALP were significantly longer than in the RRP group (both P < 0.001). However, the estimated blood loss and amount of administered fluids in RALP were significantly lower than in RRP (both P < 0.001). Also, RALP demonstrated a significantly lower incidence of transfusion and smaller amount of transfused packed red blood cells than RRP (both P < 0.001). Importantly, the incidence of AKI in RALP was significantly lower than in RRP (5.5% vs 10.4%; P = 0.044). Furthermore, the length of hospital stay in RALP was also significantly shorter (P < 0.001).The incidence of AKI after RALP is significantly lower than after RRP. RALP can therefore be a better surgical option than RRP in terms of decreasing the frequency of postoperative AKI.

Effect of intraoperative mannitol administration on acute kidney injury after robot-assisted laparoscopic radical prostatectomy

“…[ 26 – 28 ] The overall incidence of AKI after RALP is reported to be approximately 5.5%. [ 5 ] In our present study, the incidence of postoperative AKI in RALP was 5.1%. Postoperative AKI is defined as an abrupt decrease of renal function, [ 29 ] and is associated with increased health costs, morbidity, and mortality.…”

“…[ 4 ] In addition, postoperative acute kidney injury (AKI) occurs at a lower incidence after RALP than after open retropubic radical prostatectomy. [ 5 ] However, postoperative AKI is linked to increased morbidity, mortality, and health costs in hospitalized patients. [ 6 , 7 ] Therefore, the prevention of postoperative AKI is important for improving the postoperative outcomes of robotic prostatectomy.…”

Complications of robotic-assisted laparoscopic surgery distant from the surgical site

“…Three studies specifically examined the incidence of AKI across the differing techniques and included analysis of diagnostic studies. [68][69][70] AKI occurred in these three studies conforming to the acute kidney injury network stage-1 criteria regarding increase in serum creatinine (either absolute increase of ! 0.3 mg dL À1 or !1.5-fold increase from baseline), or decrease in urine output (<0.5 mL kg À1 h À1 for >6 h) with a reported incidence of 5.5-6.5% across robotic cases.…”

“…0.3 mg dL À1 or !1.5-fold increase from baseline), or decrease in urine output (<0.5 mL kg À1 h À1 for >6 h) with a reported incidence of 5.5-6.5% across robotic cases. [68][69][70] Among the studies examined there was no clear relationship regarding the incidence of AKI with surgical technique, with some studies finding a lowered incidence in robotic cases, that was thought to relate to decreased blood loss and blood transfusions administered. 68 70 One paper mentioned a total of 17 in 293 cases (5.8%) without reference to specific criteria.…”

Robot-assisted partial nephrectomy: How to minimise renal ischaemia

“…The incidence of acute kidney injury (AKI) in patients who undergo NSS remains controversial. Studies have shown that overall incidence of AKI, measured either as an increase in serum creatinine or fall in urine output, is 5.5–6.5% across RAPN cases [40] , [41] . The suggested preventative non-surgical strategies include aggressive fluid hydration to produce a diuresis of >200 mL/h [42] and to keep the pneumoperitoneum pressures at ≤15 mmHg [43] .…”