ABSTRACT
Abstract Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively. Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. Trial Registry Number: Clinicaltrials.gov (N° NCT03018522).
Resumo Introdução: O presente estudo investigou a associação entre Disfunção Cognitiva Pós-Operatória (DCPO) e aumento do nível sérico de S100B após Prostatectomia Radical Laparoscópica Assistida por Robô (PRLAR). Métodos: O estudo incluiu 82 pacientes consecutivos submetidos à PRLAR. Os níveis séricos de S100B foram determinados: no pré-operatório, após indução anestésica, e aos 30 minutos e 24 horas do pós-operatório. A função cognitiva foi avaliada com testes neuropsicológicos no pré-operatório, no 7° dia pós-operatório (7 DPO) e aos 3 meses após a cirurgia (3 MPO). Resultados: Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) após 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os níveis séricos de S100B estavam significantemente aumentados aos 30 minutos e às 24 horas do pós-operatório nos pacientes que apresentaram DCPO no 7 DPO (p= 0,0001 para os dois momentos) e 3 meses após a cirurgia (p= 0,001 para os dois momentos) A duração anestésica também foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparação com pacientes sem DCPO (p= 0,012, p= 0,001, respectivamente), assim como a duração da posição de Trendelenburg (p= 0,025, p= 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duração da posição de Trendelenburg e a duração da anestesia (p= 0,0001 para ambos). Conclusão: S100B aumenta após PRLAR e o aumento está associado ao desenvolvimento de DCPO. A duração anestésica e o tempo decorrido em posição de Trendelenburg contribuem para o desenvolvimento de DCPO. Número de registro do estudo: Clinicaltrials.gov (n° NCT03018522)
Subject(s)
Humans , Male , Aged , Postoperative Complications/blood , Prostatectomy/adverse effects , Cognitive Dysfunction/blood , S100 Calcium Binding Protein beta Subunit/blood , Robotic Surgical Procedures/adverse effects , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Prostatectomy/methods , Time Factors , Biomarkers/blood , Case-Control Studies , Prospective Studies , Sensitivity and Specificity , Head-Down Tilt/adverse effects , Area Under Curve , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , Operative Time , Robotic Surgical Procedures/methods , Anesthesia, General/adverse effects , Anesthesia, General/statistics & numerical data , Middle Aged , Neuropsychological TestsABSTRACT
Objective To investigate the effect of pelvic floor stabilized structure preservation (PPSS) during robot-assisted laparoscopic radical prostatectomy (RARP)on postoperative continence recovery.Methods From October 2017 to April 2018,86 patients with prostatic cancer who underwent traditional RARP and RARP plus PPSS were included.There were 31 patients in non-PPSS group and 55 patients in PPSS group.In non-PPSS group,patients age was (68.48 ± 7.79) years old,BMI was (24.79 ± 3.05) kg/m2,median prostate volume was 63.54 (53.00-99.36) cm3,clinic T-stage T1-T2,T3,T4 accounted for 49.39％,22.58％,6.45％ and ISUP grade 1,2,3,4,5 accounted for 22.58％,22.81％,12.90％,12.90％,19.35％ respectively.In PPSS group,patients age was (69.53 ± 6.81)years old,BMI was (23.95 ± 3.03) kg/m2,median prostate volume was 73.39 (54.88-94.23) cm3,clinic T-stage T1-T2,T3,T4 accounted for 72.73％,7.27％,3.64％ and ISUP grade 1,2,3,4,5 accounted for 21.82％,18.18％,23.64％,18.18％,10.91％ respectively.The preoperative PSA,BMI,clinical T-stage,ISUP grade,and postoperative hospital days had no significant differences (P ＞ 0.05)between the two groups.Both groups were operated via transperitoneal approach.In the non PPSS group,endo-pelvic fascia and pubic prostate ligament was cut,and dorsal vessel complex was ligated.In PPSS group,the partial endo-pelvic fascia was bluntly pushed to the pelvic wall to preserve tendon arch,and pubic prostate ligament also was preserved without suturing and ligating dorsal vascular complex.The catheter was removed 7 d after RARP.The continence recovery were compared between the two groups,including pad number on the day of I,7,14,30,90 and ICI-Q-SF scores on the day of 30 and 90 after catheter removal.Results There was no significant difference in pad numbers used between the two groups on the day of 1,7,14,30 after catheter removal.On the 90th day,the proportions of using pad ≥4 in PPSS group were significantly lower than those in non-PPSS group (1.89％ vs.20.69％,P =0.004).No significant difference was found in ICI-Q-SF scores on the 30th and 90th day between the two groups.Univariate analysis showed that PPSS group used less pads than non-PPSS group on the 90th day [OR =0.07(95％ CI 0.01-0.65),P =0.019];T3 patients used more pads than T1-T2 patients [OR =9.19 (95％ CI 1.32-63.87),P =0.025].After adjusting for age,ISUP grading,T staging,and PSA,multivariate regression analysis showed that the risk of using pad ≥ 4 in PPSS group compared with non-PPSS group was 0.46,0.34,0.27,0.25,and 0.03 on the day of 1,7,14,30 and 90 after catheter removal,respectively.The PPSS approach didn't increase the risk of positive surgical margin.Conclusions Preservation of pelvic stabilized structure in RARP is very efficient in term of continence rate after RARP,and it does not increase the risk of positive surgical margin.
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Objective To study the short-term effectiveness of robotic-assisted laparoscopic radical prostatectomy in high-risk prostate cancer.Methods From March 2012 to March 2017,400 patients with high-risk prostate who underwent robotic-assisted laparoscopic radical prostatectomy were reviewed.The median age was 68 years old(ranged from 49 to 83 years),and the median PSA was 23.1 ng/ ml(ranged from 5.2 to 999.0 ng/ml).Preoperative parameters,surgical interventional data,postoperative pathology and follow-up data were collected.Logistic regression was used to analyze the risk factors of positive surgical margin in postoperative pathology.Results All the operations were successfully completed.Median operation time was 115 min(ranged 50-555 min),and median estimated blood loss was 110 ml(ranged 30-500 ml).Six patients had perioperative complications,among which two were rectal injury,two were cardio-cerebrovascular disease and two were hemorrhage.There was no perioperative death.Positive surgical margin was detected in 151 patients,accounting for 37.8％.A total of 345 cases (86.3％) underwent lymphadenectomy,of which 253 cases (63.3％) were performed standardized resection and 92 cases (23％) were performed extensive resection.The median number of resected lymph nodes was 9 (ranged 3-36).Eighty cases (23.2％,80/345) were positive in resected lymph nodes.Regression analysis showed that preoperative PSA ＞ 20 ng / ml or clinical stage ≥ T2c were risk factors for positive surgical margins.After a median follow-up of 14.4 months (ranged 2.0-58.8 months),the overall incidence of biochemical recurrence was 33.4％ (107/320),and the urinary continence rate one year after operation was 86.6％ (277/320).Conclusions Robotic-assisted laparoscopic radical prostatectomy in patients with high-risk prostate cancer was a feasible,safe and effective approach.Preoperative PSA and clinical stage were the risk factors for positive surgical margin.
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Objective To introduce the technique and report our initial experience of Retziussparing robotic-assisted laparoscopic radical prostatectomy (RALP) and compare perioperative outcomes with the standard veil of Aphrodite technique (Veil technique).Methods nineteen Retzius-sparing RALP and 20 Veil nerve sparing RALP with posterior reconstruction for T1c to T2c prostate cancer performed by a single surgical team between 2015 January and 2016 December were retrospectively reviewed.Preoperative data of patients in Retzius-sparing group [patient age (66.3 ± 5.9) years,BMI (25.5 ± 3.1) kg/m2,tPSA (16.4 ± 5.0) ng/ml,biopsy Gleason score 6 (5-7),prostate volume (32.7 ± 7.4) ml and IIEF-5 score 14(5-18)] and Veil group[patient age (64.6 ±7.3) years,BMI (25.5 ±2.0) kg/m2,tPSA (18.5 ± 11.0) ng/ml,biopsy Gleason score 7(5-8),prostate volume (31.4± 10.8)ml and IIEF-5 score 15(6-19)].No significant difference was found between the two group in the above parameters (all P ＞ 0.05).All patients were continent preoperatively.Retzius-sparing RALP and Veil nerve sparing RALP were performed via transperitoneal RALP.Operative time,estimated blood loss,postoperative hospital stay,postoperative staging,postoperative Gleason score,return of urinary continence and postoperative IIEF-5 score of the two groups were statistically analyzed.Results All 39 cases were successfully performed robotically without conversion,transfusion or other major intraoperative and postoperative complications.Postoperative pathology confirmed pT2a 5 cases,pT2b 8 cases and pT2c 6 cases in Retzius-sparing group and pT2a 7 cases,pT2b 5 cases and pT2c 8 cases in Veil group (all P ＞ 0.05).For Retzius group,operative time was (106.5 ± 26.4) min and estimated blood loss was (48.9 ± 20.2) ml;for Veil group,operative time was (93.2± 20.8) min and estimated blood loss was (42.5 ± 16.8) ml.No significant difference was found in the above parameters (all P ＞ 0.05).Urethral catheter was removed at postoperative 7-day (Retzius-sparing group) and 21-day (Veil group),respectively.18 patients in Retzius-sparing group achieved urinary continence (0 pads) immediately after the removal of urinary catheter,while 1 patient returned to full continence in 2 weeks postoperatively.Patients in Veil group returned to continence (6.8 ± 3.6) weeks postoperatively (P ＜ 0.001).At 3-month follow up,IIEF-5 score was 14 (4-16) in Retziussparing group and 14 (4-18) in Veil group;no significant changes was noted in preoperative and postoperative IIEF-5 score in both groups,or in postoperative IIEF-5 scores in the two groups (P ＞ 0.05).No sign of tumor recurrence was appreciated for all cases (tPSA ＜ 0.2 ng/ml) during follow-up of 6 months (3 to 12 months).Conclusions Retzius-sparing RALP and the Veil nerve sparing RALP were both effective for the surgical treatment of localized prostate cancer.Our data revealed no statistical difference in perioperative outcomes between the two approaches,however,the Retzius-sparing technique seemed to yield a better outcome regarding early return to urinary continence postoperatively.