Is a Drain Needed After Robotic Radical Prostatectomy With or Without Pelvic Lymph Node Dissection? Results of a Single-Center Randomized Clinical Trial

Porcaro, Antonio Benito; Siracusano, Salvatore; Bizzotto, Leonardo; Sebben, Marco; Cacciamani, Giovanni; Luyk, Nicolò De; Corsi, Paolo; Tafuri, Alessandro; Processali, Tania; Mattevi, Daniele; Cerruto, Maria Angela; Brunelli, Matteo; Novella, Giovanni; Marco, Vincenzo De; Artibani, Walter

doi:10.1089/end.2018.0176

Cited by 22 publications

(17 citation statements)

References 22 publications

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“…The rates of symptomatic lymphocoele were 2.2% in the ND arm compared to 4.1% in the PD arm ( P = .7). Another randomized, non‐inferiority study by Porcaro et al 7 involving 112 patients (two excluded from analysis) showed an overall complication rate of 28.9% in the PD group versus 20.4% in the ND group ( P = .254). There were no complications classed as Clavien 3 or above in the ND group compared to three cases in the PD group.…”

Section: Resultsmentioning

confidence: 98%

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Review of the use of prophylactic drain tubes post‐robotic radical prostatectomy: Dogma or decent practice?

et al. 2020

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Objective To assess the necessity of routine prophylactic drain tube use following robot‐assisted radical prostatectomy (RARP). Method We performed a literature review using the Medline, Scopus, and Web of Science databases with no restriction of language from January 1900 to January 2020. The following terms we used in the literature search: prostatectomy, radical prostatectomy, robot assisted, drainage, and drain tube. Results We identified six studies that examined the use of routine prophylactic drain tubes following RARP. One of these studies was a randomized study that included 189 patients, with 97 in the pelvic drain (PD) arm and 92 in the no pelvic drain (ND) arm. This non‐inferiority showed an early (90‐day) complication rate of 17.4% in the ND arm versus 26.8% in the PD arm (P < .001). Another non‐inferiority randomized control trial (RCT) showed a complication rate of 28.9% in the PD group versus 20.4% in the ND group (P = .254). Similarly, the other studies found no benefit of routine use of prophylactic drain tube after RARP. Conclusion Drain tubes play a role during robotic‐assisted radical prostatectomy, however, following a review of the current available literature, they can be safely omitted and we suggest that clinicians may be selective in their use.

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Section: Resultsmentioning

confidence: 98%

“…One study did not accrue as initially intended and as such the final sample study in this analysis is small 5 . The other RCT it was a single center study with small numbers and only two surgeons 7 . This raises questions about applicability of the findings to the general population.…”

Section: Discussionmentioning

confidence: 99%

Review of the use of prophylactic drain tubes post‐robotic radical prostatectomy: Dogma or decent practice?

et al. 2020

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“…In RARP cases, transurethral 16 French Foley bladder catheter was placed and removed on post-operative day (POD) 12 without cystography according to our standard internal protocol. After December 2017, our policy of placing a pelvic drain was discontinued according to our previous reported experience [ 16 ]. In ORP patients, a transurethral 16 French Foley bladder catheter was placed and removed on POD 12 with or without cystography according to the surgeon’s decision; moreover, a pelvic drain was always placed and removed on POD 2 or 3.…”

Section: Methodsmentioning

confidence: 99%

Predictors of complications occurring after open and robot-assisted prostate cancer surgery: a retrospective evaluation of 1062 consecutive patients treated in a tertiary referral high volume center

et al. 2021

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To investigate factors associated with the risk of major complications after radical prostatectomy (RP) by the open (ORP) or robot-assisted (RARP) approach for prostate cancer (PCa) in a tertiary referral center. 1062 consecutive patients submitted to RP were prospectively collected. The following outcomes were addressed: (1) overall postoperative complications: subjects with Clavien-Dindo System (CD) one through five versus cases without any complication; (2) moderate to major postoperative complications: cases with CD < 2 vs. ≥ 2, and 3) major post-operative complications: subjects with CDS CD ≥ 3 vs. < 3. The association of pre-operative and intra-operative factors with the risk of postoperative complications was assessed by the logistic regression model. Overall, complications occurred in 310 out of 1062 subjects (29.2%). Major complications occurred in 58 cases (5.5%). On multivariate analysis, major complications were predicted by PCa surgery and intraoperative estimated blood loss (EBL). ORP compared to RARP increased the risk of major CD complications from 2.8 to 19.3% (OR = 8283; p < 0.0001). Performing ePLND increased the risk of major complications from 2.4 to 7.4% (OR = 3090; p < 0.0001). Assessing intraoperative blood loss, the risk of major postoperative complications was increased by BL above the third quartile when compared to subjects with intraoperative blood loss up to the third quartile (10.2% vs. 4.6%; OR = 2239; 95%CI: 1233–4064). In the present cohort, radical prostatectomy showed major postoperative complications that were independently predicted by the open approach, extended lymph-node dissection, and excessive intraoperative blood loss.

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“…Extended pelvic lymph node dissection (ePLND) was performed in 581 patients (59.3%). The median (IQR) number of removed lymph nodes was 26 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Overall, perioperative blood transfusion was necessary in 39 patients (4%); 4 intraoperatively, 35 post-operatively.…”

Section: Risk Of Blood Transfusionmentioning

confidence: 99%

Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

et al. 2021

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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.

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Is a Drain Needed After Robotic Radical Prostatectomy With or Without Pelvic Lymph Node Dissection? Results of a Single-Center Randomized Clinical Trial

Cited by 22 publications

References 22 publications

Review of the use of prophylactic drain tubes post‐robotic radical prostatectomy: Dogma or decent practice?

Review of the use of prophylactic drain tubes post‐robotic radical prostatectomy: Dogma or decent practice?

Predictors of complications occurring after open and robot-assisted prostate cancer surgery: a retrospective evaluation of 1062 consecutive patients treated in a tertiary referral high volume center

Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

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