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

作者：Djavan Bob^*; Agalliu Ilir; Laze Juliana; Sadri Helen; Kazzazi Amir; Lepor Herbert

来源：BJU International, 2012, 110(1): 69-75.

DOI：10.1111/j.1464-410X.2011.10812.x

• radical prostatectomy
• blood loss
• clinical outcomes
• oncological outcomes
• functional outcomes
• complication rates

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 defined.
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.

• 出版日期2012-7