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

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

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVE: • To determine the short- and long-term impact of blood loss (BL) on clinical, oncological and functional outcomes as well as complication rates after an open radical retropubic prostatectomy (ORRP). PATIENTS AND METHODS: • Between 2000 and 2008, 1567 men who underwent an ORRP participated in our prospective longitudinal outcomes study. • Haematocrit (Hct) levels, transfusion rates, BL and complications were recorded prospectively. • Validated, self-administered quality-of-life (QoL) questionnaires were completed at baseline, 3, 6 and 12 months and yearly thereafter. • Urinary function and erectile dysfunction were assessed using AUA Symptom Score and the UCLA Prostate Cancer Index and analysis of variance ( ANOVA )/chi-square tests were used to compare clinical, BL, biochemical recurrence (BCR) and QoL outcomes amongst the three groups for continuous/categorical variables. RESULTS: • The mean estimated BL was 742.7 (45 to 3500) mL and 5.4% and 3.8% received an autologous (AU) or allogeneic (AL) blood transfusions, respectively. • The average baseline, induction, postoperative and discharge Hct was 43.8%, 48.3%, 35.7% and 34.1%, respectively. • The estimated BL and the rate of change of Hct correlated moderately ( r = 0.41, P < 0.0001). • Tertiles of BL were based on the difference between induction and discharge Hct (Delta 1) and the average Delta 1 for Groups 1, 2 and 3 were 7.9%, 12.7% and 17.2%, respectively. • Intra-operative, early/delayed complications, length of hospital stay (LoS), SM surgical margins status, anastomotic stricture and BCR were not statistically different ( P < 0.001) and the mean AUASS, UCLA Prostate Cancer urinary bother scores, urinary function scores, sexual bother/function scores at 24 months were similar amongst all tertiles ( P > 0.05). CONCLUSIONS: • BL during ORRP does not adversely impact clinical and functional outcomes irrespective of how BL is defi ned. • Thus, the lower BL associated with robotic-assisted laparoscopic prostatectomy (RALP) in and of itself would not be expected to improve functional or oncological outcomes.

Original languageEnglish (US)
Pages (from-to)69-75
Number of pages7
JournalBJU International
Volume110
Issue number1
DOIs
StatePublished - Jul 2012

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Prostatectomy
Hematocrit
Blood Transfusion
Quality of Life
Robotics
Erectile Dysfunction
Chi-Square Distribution
Longitudinal Studies
Prostatic Neoplasms
Analysis of Variance
Outcome Assessment (Health Care)
Recurrence

Keywords

  • Blood loss
  • Clinical outcomes
  • Complication rates
  • Functional outcomes
  • Oncological outcomes
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

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.

In: BJU International, Vol. 110, No. 1, 07.2012, p. 69-75.

Research output: Contribution to journalArticle

Djavan, Bob ; Agalliu, Ilir ; Laze, Juliana ; Sadri, Helen ; Kazzazi, Amir ; Lepor, Herbert. / Blood loss during radical prostatectomy : Impact on clinical, oncological and functional outcomes and complication rates. In: BJU International. 2012 ; Vol. 110, No. 1. pp. 69-75.
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T2 - Impact on clinical, oncological and functional outcomes and complication rates

AU - Djavan, Bob

AU - Agalliu, Ilir

AU - Laze, Juliana

AU - Sadri, Helen

AU - Kazzazi, Amir

AU - Lepor, Herbert

PY - 2012/7

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N2 - OBJECTIVE: • To determine the short- and long-term impact of blood loss (BL) on clinical, oncological and functional outcomes as well as complication rates after an open radical retropubic prostatectomy (ORRP). PATIENTS AND METHODS: • Between 2000 and 2008, 1567 men who underwent an ORRP participated in our prospective longitudinal outcomes study. • Haematocrit (Hct) levels, transfusion rates, BL and complications were recorded prospectively. • Validated, self-administered quality-of-life (QoL) questionnaires were completed at baseline, 3, 6 and 12 months and yearly thereafter. • Urinary function and erectile dysfunction were assessed using AUA Symptom Score and the UCLA Prostate Cancer Index and analysis of variance ( ANOVA )/chi-square tests were used to compare clinical, BL, biochemical recurrence (BCR) and QoL outcomes amongst the three groups for continuous/categorical variables. RESULTS: • The mean estimated BL was 742.7 (45 to 3500) mL and 5.4% and 3.8% received an autologous (AU) or allogeneic (AL) blood transfusions, respectively. • The average baseline, induction, postoperative and discharge Hct was 43.8%, 48.3%, 35.7% and 34.1%, respectively. • The estimated BL and the rate of change of Hct correlated moderately ( r = 0.41, P < 0.0001). • Tertiles of BL were based on the difference between induction and discharge Hct (Delta 1) and the average Delta 1 for Groups 1, 2 and 3 were 7.9%, 12.7% and 17.2%, respectively. • Intra-operative, early/delayed complications, length of hospital stay (LoS), SM surgical margins status, anastomotic stricture and BCR were not statistically different ( P < 0.001) and the mean AUASS, UCLA Prostate Cancer urinary bother scores, urinary function scores, sexual bother/function scores at 24 months were similar amongst all tertiles ( P > 0.05). CONCLUSIONS: • BL during ORRP does not adversely impact clinical and functional outcomes irrespective of how BL is defi ned. • Thus, the lower BL associated with robotic-assisted laparoscopic prostatectomy (RALP) in and of itself would not be expected to improve functional or oncological outcomes.

AB - OBJECTIVE: • To determine the short- and long-term impact of blood loss (BL) on clinical, oncological and functional outcomes as well as complication rates after an open radical retropubic prostatectomy (ORRP). PATIENTS AND METHODS: • Between 2000 and 2008, 1567 men who underwent an ORRP participated in our prospective longitudinal outcomes study. • Haematocrit (Hct) levels, transfusion rates, BL and complications were recorded prospectively. • Validated, self-administered quality-of-life (QoL) questionnaires were completed at baseline, 3, 6 and 12 months and yearly thereafter. • Urinary function and erectile dysfunction were assessed using AUA Symptom Score and the UCLA Prostate Cancer Index and analysis of variance ( ANOVA )/chi-square tests were used to compare clinical, BL, biochemical recurrence (BCR) and QoL outcomes amongst the three groups for continuous/categorical variables. RESULTS: • The mean estimated BL was 742.7 (45 to 3500) mL and 5.4% and 3.8% received an autologous (AU) or allogeneic (AL) blood transfusions, respectively. • The average baseline, induction, postoperative and discharge Hct was 43.8%, 48.3%, 35.7% and 34.1%, respectively. • The estimated BL and the rate of change of Hct correlated moderately ( r = 0.41, P < 0.0001). • Tertiles of BL were based on the difference between induction and discharge Hct (Delta 1) and the average Delta 1 for Groups 1, 2 and 3 were 7.9%, 12.7% and 17.2%, respectively. • Intra-operative, early/delayed complications, length of hospital stay (LoS), SM surgical margins status, anastomotic stricture and BCR were not statistically different ( P < 0.001) and the mean AUASS, UCLA Prostate Cancer urinary bother scores, urinary function scores, sexual bother/function scores at 24 months were similar amongst all tertiles ( P > 0.05). CONCLUSIONS: • BL during ORRP does not adversely impact clinical and functional outcomes irrespective of how BL is defi ned. • Thus, the lower BL associated with robotic-assisted laparoscopic prostatectomy (RALP) in and of itself would not be expected to improve functional or oncological outcomes.

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