Factors Affecting Peroperative Bleeding Amount and Need for Blood Transfusion in Retropubic Radical Prostatectomy Operation

Year 2023, Volume: 45 Issue: 6, 947 - 955, 24.10.2023

Osman Gercek , Veli Mert Yazar , Murat Cengizhan Atik , Kutay Topal

https://doi.org/10.20515/otd.1349147

Abstract

Intraoperative blood loss is one of the important complications of radical prostatectomy. Appropriate perioperative risk stratification may reduce the possibility of intraoperative blood transfusion. In this study, we aimed to reveal the risk factors that may cause bleeding. 180 patients who were diagnosed with prostate cancer by conventional transrectal ultrasonography biopsy (TRUS-Bx) and underwent retropubic radical prostatectomy (RP) were included in our study. The relationship between the mean blood loss during the operation and the clinical and pathological findings of the patient was examined. Factors that could affect the amount of bleeding and predict the amount of bleeding before the operation were tried to be revealed. The time between TRUS-Bx and RP was statistically significantly longer in patients with a large amount of bleeding (p=0.005). When the level of peroperative bleeding was compared with the TRUS-Bx and RP ISUP scores, both TRUS-Bx and RP ISUP values were statistically significantly higher in patients with high bleeding (>845 cc) (respectively; p=0.024, p<0.001). A 1-unit increase in the TRUS-Bx ISUP score was associated with an increase of 100.04 cc in the amount of peroperative bleeding. In the logistic regression analysis, the most important predictor for the amount of perioperative bleeding was RP ISUP grade (p=0.003). In high-stage patients, bleeding occurs more during the operation. In patients with an ISUP grade and a high biopsy tumor percentage, more careful dissection may reduce the amount of perioperative bleeding. It should be kept in mind that the cancer stage may be higher than the biopsy pathology in patients with a large amount of intraoperative bleeding.

Keywords

Prostate cancer, bleeding, prostatectomy

Retropubik Radikal Prostatektomi Operasyonunda Peroperatif Kanama Miktarını ve Kan Transfüzyonu İhtiyacını Etkileyen Faktörler

Abstract

İntraoperatif kan kaybı radikal prostatektominin önemli komplikasyonlarından biridir. Perioperatif uygun risk sınıflamasının yapılması intraoperatif kan transfüzyonu ihtimalini azaltabilir. Biz bu çalışmada kanamaya neden olabilecek risk faktörlerini ortaya koymayı amaçladık. Çalışmamıza konvansiyonel transrektal ultrasonografi biyopsi (TRUS-Bx) ile prostat kanseri tanısı konulan ve retropubik radikal prostatektomi (RP) operasyonu gerçekleştirilen 180 hasta dahil edildi. Operasyonda gerçekleşen ortalama kan kaybı ile hastanın klinik ve patolojik bulgularının ilişkisi incelendi. Kanama miktarına etki edebilecek ve operasyon öncesi kanama miktarını öngörebilecek faktörler ortaya konulmaya çalışıldı. Kanama miktarı fazla olan hastalarda TRUS-Bx ile RP arasında geçen süre istatistiksel anlamlı olarak daha uzundu (p=0.005). Peroperatif kanama düzeyi ile TRUS-Bx ve RP ISUP skorlarının karşılaştırıldığında, kanama miktarı yüksek olan (>845 cc) hastalarda hem TRUS-Bx hem de RP ISUP değerleri istatistiksel olarak anlamlı daha yüksek izlendi (sırasıyla; p=0,024, p<0,001). TRUS-Bx ISUP skorunda 1 birimlik artış, peroperatif kanama miktarında 100.04 cc artışla ilişkili bulunmuştur. Lojistik regresyon analizinde peroperatif kanama miktarı için en önemli prediktör RP ISUP derecesiydi (p=0,003). Yüksek evre hastalarda operasyon sırasında kanama daha çok olmaktadır. ISUP derecesi ve biyopsi tümör yüzdesi yüksek olan hastalarda daha dikkatli bir diseksiyon, peroperatif kanama miktarını azaltabilir. Intraoperatif kanama miktarı fazla olan hastalarda kanser evresinin biyopsi patolojisine göre daha yüksek olabileceği unutulmamalıdır.

Keywords

Prostat kanseri, kanama, prostatektomi

References

• 1. Boehm K, Beyer B, Tennstedt P, Schiffmann J, Budaeus L, Haese A, et al. No impact of blood transfusion on oncological outcome after radical prostatectomy in patients with prostate cancer. World J Urol. 2015;33(6):801-6.
• 2. Nuttall GA, Cragun MD, Hill DL, Morris TJ, Decker PA, Blute ML, et al. Radical retropubic prostatectomy and blood transfusion. Mayo Clin Proc. 2002;77(12):1301-5.
• 3. Djavan B, Agalliu I, Laze J, Sadri H, Kazzazi A, Lepor H. Blood loss during radical prostatectomy: impact on clinical, oncological and functional outcomes and complication rates. BJU Int. 2012;110(1):69-75.
• 4. Kordan Y, Barocas DA, Altamar HO, Clark PE, Chang SS, Davis R, et al. Comparison of transfusion requirements between open and robotic-assisted laparoscopic radical prostatectomy. BJU Int. 2010;106(7):1036-40.
• 5. Cirasino L, Barosi G, Torre M, Crespi S, Colombo P, Belloni PA. Preoperative predictors of the need for allogeneic blood transfusion in lung cancer surgery. Transfusion. 2000;40(10):1228-34.
• 6. Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011;83(6):719-24.
• 7. Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth. 2012;109 Suppl 1:i29-i38.
• 8. Tai YH, Wu HL, Mandell MS, Tsou MY, Chang KY. The association of allogeneic blood transfusion and the recurrence of hepatic cancer after surgical resection. Anaesthesia. 2020;75(4):464-71.
• 9. Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. European urology. 2012;61(3):480-7.
• 10. Gandaglia G, Fossati N, Zaffuto E, Bandini M, Dell’Oglio P, Bravi CA, et al. Development and internal validation of a novel model to identify the candidates for extended pelvic lymph node dissection in prostate cancer. European urology. 2017;72(4):632-40.
• 11. Farnham SB, Webster TM, Herrell SD, Smith JA, Jr. Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy. Urology. 2006;67(2):360-3.
• 12. Carini M, Masieri L, Minervini A, Lapini A, Serni S. Oncological and functional results of antegrade radical retropubic prostatectomy for the treatment of clinically localised prostate cancer. Eur Urol. 2008;53(3):554-61.
• 13. Stav K, Rahimi-Levene N, Lindner A, Siegel YI, Zisman A. Retropubic radical prostatectomy: associated blood loss and transfusion requirements--a two-decade perspective review. Isr Med Assoc J. 2005;7(2):103-6.
• 14. Chang SS, Duong DT, Wells N, Cole EE, Smith JA, Jr., Cookson MS. Predicting blood loss and transfusion requirements during radical prostatectomy: the significant negative impact of increasing body mass index. J Urol. 2004;171(5):1861-5.
• 15. Coakley FV, Eberhardt S, Wei DC, Wasserman ES, Heinze SB, Scardino PT, et al. Blood loss during radical retropubic prostatectomy: relationship to morphologic features on preoperative endorectal magnetic resonance imaging. Urology. 2002;59(6):884-8.
• 16. Dash A, Dunn RL, Resh J, Wei JT, Montie JE, Sanda MG. Patient, surgeon, and treatment characteristics associated with homologous blood transfusion requirement during radical retropubic prostatectomy: multivariate nomogram to assist patient counseling. Urology. 2004;64(1):117-22.
• 17. Chan RC, Barocas DA, Chang SS, Herrell SD, Clark PE, Baumgartner R, et al. Effect of a large prostate gland on open and robotically assisted laparoscopic radical prostatectomy. BJU international. 2008;101(9):1140-4.
• 18. Eroglu M, Doluoglu OG, Sarici H, Telli O, Ozgur BC, Bozkurt S. Does the time from biopsy to radical prostatectomy affect Gleason score upgrading in patients with clinical t1c prostate cancer? Korean J Urol. 2014;55(6):395-9.
• 19. Donnem T, Hu J, Ferguson M, Adighibe O, Snell C, Harris AL, et al. Vessel co-option in primary human tumors and metastases: an obstacle to effective anti-angiogenic treatment? Cancer Med. 2013;2(4):427-36.
• 20. Qian CN, Pezzella F. Tumor vasculature: a sally port for inhibiting cancer cell spreading. Cancer Commun (Lond). 2018;38(1):52.