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Tanabe S, Ichida K, Niiya K, Morishima S. A case of severe pulmonary embolism after total robotic hysterectomy despite venous thromboembolism prophylaxis as prescribed. Int J Surg Case Rep 2024; 116:109396. [PMID: 38367419 PMCID: PMC10944000 DOI: 10.1016/j.ijscr.2024.109396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION We report the case of a patient who developed a severe pulmonary embolus postoperatively despite perioperative venous thromboembolism (VTE) prophylaxis as prescribed. PRESENTATION OF CASE A 50-year-old female patient underwent a robotic total hysterectomy for uterine fibroids. Her perioperative VTE risk was assessed as moderate, and compression and intermittent air compression stockings were used postoperatively until the morning following the surgery. The surgery was uneventful, and the patient was discharged on postoperative day 4. On postoperative day 19, the patient experienced rapid dyspnea and was diagnosed with a severe pulmonary embolus. DISCUSSION Heparin, a tissue-type plasminogen activator, and a catecholamine were administered, and the patient recovered well. CONCLUSION VTE measures in minimally invasive gynecologic surgery are not well defined, and future thrombotic risk assessments specific to minimally invasive gynecologic surgery may be necessary.
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Koelker M, Bradtke M, Klemm J, von Deimling M, Gild P, Dahlem R, Fisch M, Rink M, Vetterlein MW. Rational peri-operative management of antithrombotic therapy in patients undergoing radical cystectomy: A 30-day morbidity analysis based on the updated European Association of Urology guidelines for standardized complication reporting. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107123. [PMID: 37879160 DOI: 10.1016/j.ejso.2023.107123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Radical cystectomy (RC) in bladder cancer patients with cardiovascular comorbidity poses challenges due to the need for antithrombotic therapy and high perioperative risk. We aimed to assess 30-day complications after RC in patients receiving antithrombotic therapy. PATIENTS AND METHODS Retrospective study of 416 bladder cancer patients (2009-2017) undergoing open RC with pelvic lymph node dissection, with or without antithrombotic therapy. Antithrombotic therapy and complication reporting followed European guidelines. Procedure-specific 30-day complications were cataloged, graded (Clavien-Dindo), and quantified using the 30-day Comprehensive Complication Index. Multivariable regressions evaluated antithrombotic therapy's independent effect on key morbidity outcomes. RESULTS Median age was 70 years, 78% were male. Patients on antithrombotic therapy were mostly male, had higher comorbidity burden, worse kidney function, more frequent incontinent diversion, and shorter operative time (all p ≤ 0.027). Bleeding complications occurred in 135 patients (32%; 95%CI = 28-37%), more prevalent with antithrombotic therapy (46% vs. 29%; p = 0.004). Thromboembolic complications occurred in 18 patients (4.3%; 95%CI = 2.6-6.8%), no difference between patients with and without antithrombotic therapy (8.4% vs. 3.3%; p = 0.063). Prevalence of myocardial infarction, new-onset hypertension, acute congestive heart failure, and angina pectoris showed no difference (all p ≥ 0.3). Multivariable analyses indicated no association between antithrombotic therapy and cardiac complications, 30-day major complications, or cumulative morbidity (all p ≥ 0.2). Antithrombotic therapy was associated with bleeding complications (OR = 1.92; 95%CI = 1.07-3.45; p = 0.028), predominantly transfusion-related (75% of 152 bleeding complications). Limitations include retrospective data assessment with biases. CONCLUSIONS RC in patients on antithrombotic therapy exhibits a higher incidence of adverse events due to underlying comorbidities. Adherence to thromboprophylaxis guidelines enables safe RC in patients with significant comorbidities, without substantial increase in major bleeding or severe thromboembolic events.
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Affiliation(s)
- Mara Koelker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlon Bradtke
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus von Deimling
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Katholisches Marienkrankenhaus, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Nakayama Y, Sakano S, Shinohara Y, Nishijima J, Ban Y, Hidaka Y, Fukuda M, Shiraishi K. The effect of antiplatelet therapy on outcomes in patients who underwent laparoscopic radical nephrectomy: A Japanese single-center study. Asian J Endosc Surg 2023; 16:679-686. [PMID: 37340623 DOI: 10.1111/ases.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES The number of patients receiving antiplatelet therapy (APT) who have undergone laparoscopic radical nephrectomy is increasing. However, it is unclear whether APT affects the outcomes of patients undergoing radical nephrectomy. We investigated the perioperative outcomes of radical nephrectomy in patients with and without APT. METHODS We retrospectively collected data from 89 Japanese patients who underwent laparoscopic radical nephrectomy for clinically diagnosed renal cell carcinoma (RCC) at Kokura Memorial Hospital between March 2013 and March 2022. We analyzed information related to APT. We divided the patients into two groups: the APT group (patients receiving APT) and the N-APT group (patients not receiving APT). Moreover, the APT group was further divided into the C-APT group (patients with continuous APT) and the I-APT group (patients with interrupted APT). We compared the surgical outcomes of these groups. RESULTS Among 89 patients eligible for the study, 25 received APT and 10 continued APT. Even though the patients who received APT had a high American Society of Anesthesiologists physical status and many complications, including smoking, diabetes, hypertension, and chronic heart failure, no significant difference in the intra- or postoperative outcomes, including bleeding complications, was observed regardless of whether the patients received APT or continued APT. CONCLUSIONS We concluded that in laparoscopic radical nephrectomy, continuation of APT is an acceptable strategy for patients with thromboembolic risk caused by interruption of APT.
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Affiliation(s)
- Yuki Nakayama
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Shigeru Sakano
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yota Shinohara
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Jun Nishijima
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yoshimasa Ban
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yukihiro Hidaka
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Masashi Fukuda
- Department of Urology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Koji Shiraishi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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Kubota M, Matsuoka T, Mine Y, Hagimoto H, Kokubun H, Murata S, Makita N, Hattori Y, Suzuki I, Abe Y, Tohi Y, Tsutsumi N, Yamasaki T, Inoue K, Kawakita M. Effect of continued perioperative antithrombotic therapy on bleeding outcomes following laparoscopic nephrectomy and nephroureterectomy. Asian J Endosc Surg 2023; 16:7-13. [PMID: 35789539 DOI: 10.1111/ases.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION In this study, we aimed to assess the impact of perioperative continuation of antithrombotic therapy on bleeding and complications in patients undergoing laparoscopic radical nephrectomy (LRN) and nephroureterectomy (LNU). METHODS This was a retrospective observational study. Patients who underwent LRN and LNU between January 2017 and July 2019 at our institution were recruited. All patients taking antithrombotic agents continued taking them during the perioperative phase (AA group). Surgical outcomes of patients in the AA group were compared with those of patients who were not taking antithrombotic agents (NA group). The primary outcome was the rate of bleeding complications. Secondary outcomes included intraoperative estimated blood loss, transfusion rate, and complications for up to 90 days. RESULTS A total of 100 patients were included in the analysis, with 36 and 64 patients assigned to the AA and NA groups, respectively. Patients in the AA group were found to have more severe comorbidities than those in the NA group, with a Charlson Comorbidity Index ≥5, totaling 14 (39%) and 12 (19%), respectively (P = .03). According to surgical outcomes, none of the patients in the AA group required secondary procedures for bleeding complications. Moreover, there were no significant differences between the groups in intraoperative blood loss, hemoglobin deficit, rate of perioperative transfusion, readmission rate, or high-grade complications. DISCUSSION These results indicate that perioperative use of antithrombotic agents does not increase the risk of bleeding and can be considered safe during LRN and LNU.
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Affiliation(s)
- Masashi Kubota
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takashi Matsuoka
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuta Mine
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroki Hagimoto
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hidetoshi Kokubun
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shiori Murata
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Noriyuki Makita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuto Hattori
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Issei Suzuki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yohei Abe
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoichiro Tohi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naofumi Tsutsumi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshinari Yamasaki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koji Inoue
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
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Bensalah K, Pignot G, Legeais D, Madec FX, Lebacle C, Doizi S, Phé V, Mathieu R, Irani J. Les complications de la néphrectomie totale et de la néphrectomie partielle : quelles sont-elles, comment les prévenir et les prendre en charge ? Prog Urol 2022; 32:928-939. [DOI: 10.1016/j.purol.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/08/2022] [Indexed: 11/21/2022]
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Wada A, Omae K, Yoshida K, Kondo T, Tanabe K, Takagi T. Comparison of surgical outcomes after robot-assisted laparoscopic partial nephrectomy between patients continuing and discontinuing aspirin therapy: a Japanese single-centre study. Jpn J Clin Oncol 2022; 52:499-505. [DOI: 10.1093/jjco/hyac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
To investigate the feasibility of continuing aspirin therapy in patients with renal tumours undergoing robot-assisted laparoscopic partial nephrectomy.
Methods
This retrospective, single-centre study included 106 patients receiving aspirin therapy who underwent robot-assisted laparoscopic partial nephrectomy. The patients were divided into two groups, including those continuing and discontinuing aspirin therapy, and their surgical outcomes were compared. To minimise potential bias, variables including patient and tumour characteristics were adjusted using 1:1 propensity score matching.
Results
Aspirin therapy was used for ischaemic heart disease in 38 patients (36%), cerebrovascular disease in 21 (20%) and others in 47 (44%). Of the 106 patients, 49 were classified to the continuing group and 57 to the discontinuing group. After matching, 24 patients were included in each group. The surgical outcomes, such as changes in the estimated glomerular filtration rate, estimated blood loss, and surgical margin positivity rate, were not significantly different between the groups. In addition, no significant difference was observed in haemoglobin level changes during surgery (continuing: −2.3 g/dl; discontinuing: −1.7 g/dl, P = 0.0676) and haemorrhagic complications (continuing: 8%; discontinuing: 4%, P = 0.500). Multivariate analysis of predictors for haemoglobin level decrease >2 g/dl or haemorrhagic complications showed that, whereas tumour complexity was an independent predictor, continuation or discontinuation of aspirin therapy was not.
Conclusion
The surgical outcomes of robot-assisted laparoscopic partial nephrectomy between patients continuing and discontinuing aspirin therapy were not significantly different, thus suggesting the feasibility of continuing aspirin therapy in selected Japanese patients.
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Albisinni S, Diamand R, Mjaess G, Assenmacher G, Assenmacher C, Loos S, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Di Maida F, Minervini A, Aoun F, Tay A, Issa R, Roumiguié M, Bajeot AS, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Sanchez-Salas R, Colomer A, Quackels T, Peltier A, Montorsi F, Briganti A, Pradere B, Moschini M, Roumeguère T. Continuing acetylsalicylic acid during Robotic-Assisted Radical Cystectomy with intracorporeal urinary diversion does not increase hemorrhagic complications: results from a large multicentric cohort. Urol Oncol 2021; 40:163.e11-163.e17. [PMID: 34580028 DOI: 10.1016/j.urolonc.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate whether continuing the antiplatelet drug acetylsalicylic acid≤100mg (ASA) during Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) increases the risk of peri-and postoperative hemorrhagic complications and overall morbidity. Indeed, guidelines recommend interrupting antiplatelet therapy before radical cystectomy; however, RARC with ICUD is associated to reduced estimated blood loss and blood transfusions compared to its open counterpart. METHODS Data from a multicentric European database were analyzed. All participating centers maintained a prospective database of patients undergoing RARC with ICUD. We identified patients receiving antiplatelet therapy by acetylsalicylic acid ≤100mg. Patients were divided into three groups: those not taking acetylsalicylic acid (no-ASA), those where ASA was continued perioperatively (c-ASA) and those where ASA was interrupted perioperatively (i-ASA). Estimated blood loss and peri-and post-operative transfusions were recorded. Hemorrhagic complications, ischemic, thrombotic and cardiac morbidity was recorded and classified using the Clavien-Dindo score by a senior urologist. RESULTS 640 patients were analyzed. Patients on acetylsalicylic acid were significantly older and had more comorbidities. No significant difference was found for estimated blood loss between no-ASA, c-ASA and i-ASA (280 vs. 300 vs. 200ml respectively; P = 0.09). Similarly, no significant difference was found for intraoperative (5% vs. 9% vs. 11%; P = 0.07) and postoperative transfusion rate (11% vs. 13% vs. 18%; P = 0.17). Higher ischemic complications were noted in the i-ASA group compared to no-ASA and c-ASA (4% vs. 0.6% vs. 1.4%; P = 0.03). On uni and multivariate logistic regression, continuing acetylsalicylic acid was not significantly associated to either major complications or post-operative transfusions. CONCLUSIONS Peri-operative acetylsalicylic acid continuation in RARC with ICUD does not increase hemorrhagic complications. Interrupting acetylsalicylic acid peri-operatively may expose patients to a higher risk of ischemic events.
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Affiliation(s)
- Simone Albisinni
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | | | | | - Shirley Loos
- Department of Urology, Cliniques de l'Europe-Saint Elisabeth, Brussels, Belgium
| | | | - Serge Holz
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Fouad Aoun
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | - Andrea Tay
- Department of Urology, Saint Georges Hospital, London, UK
| | - Rami Issa
- Department of Urology, Saint Georges Hospital, London, UK
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Anne Sophie Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sarah Einerhand
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Anna Colomer
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Thierry Quackels
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Anceschi U, Brassetti A, Torregiani G, Tuderti G, Costantini M, Mastroianni R, Bove AM, Ferriero MC, Gallucci M, Simone G. The impact of anticoagulant and antiplatelet drugs therapy on perioperative outcomes of purely off-clamp robot-assisted partial nephrectomy: a single-center experience. Minerva Urol Nephrol 2020; 73:265-268. [PMID: 33256365 DOI: 10.23736/s2724-6051.20.04179-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Umberto Anceschi
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy -
| | - Aldo Brassetti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Manuela Costantini
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Alfredo M Bove
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria C Ferriero
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Oshima M, Washino S, Nakamura Y, Konishi T, Saito K, Arai Y, Miyagawa T. Risks and complications of robot-assisted radical prostatectomy (RARP) in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study in a single institute. J Robot Surg 2020; 15:661-670. [PMID: 33044699 PMCID: PMC8295093 DOI: 10.1007/s11701-020-01154-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
The objective of the study was to evaluate the risk of bleeding complications in patients undergoing robot-assisted radical prostatectomy (RARP) while taking antiplatelet (AP) and/or anticoagulant (AC) agents. We analyzed the data of 334 patients undergoing RARP from May 2015 to May 2019. Patients were categorized into AP, AC, and control groups; the bleeding complications were compared among them. The end points were the estimated blood loss, decrease in hemoglobin level, and bleeding complications. The patient characteristics did not differ significantly among groups, with the exception of ASA scores, which were significantly higher in the AP and AC groups vs. the control group. The estimated blood loss and hemoglobin decrease were not significantly different between the AP and AC groups and the control group. The frequency of bleeding complications did not differ significantly between the AP and the control groups, but was significantly higher in the AC vs. the control group (4.3% in the AP and 23.5% in the AC group vs. 3.7% in the control group; P = 0.63 and P < 0.01, respectively). There was no significant difference in bleeding complications between the AP continuation (continuation of a single AP) and the AP interruption group or between the heparin bridging and the AC interruption group. All bleeding complications observed in the AC group occurred after resuming AC therapy. RARP can be performed safely with continuation of a single AP, and in patients taking ACs by interrupting these agents or via heparin bridging, without increasing intraoperative bleeding, whereas postoperative bleeding complications may increase after resuming ACs.
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Affiliation(s)
- Masashi Oshima
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Saitama-shi, Saitama, 330-8503, Japan.
| | - Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Saitama-shi, Saitama, 330-8503, Japan
| | - Yuhki Nakamura
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Saitama-shi, Saitama, 330-8503, Japan
| | - Tsuzumi Konishi
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Saitama-shi, Saitama, 330-8503, Japan
| | - Kimitoshi Saito
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Saitama-shi, Saitama, 330-8503, Japan
| | - Yoshiaki Arai
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Saitama-shi, Saitama, 330-8503, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Saitama-shi, Saitama, 330-8503, Japan
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Wessels F, Kriegmair MC, Oehme A, Rassweiler-Seyfried MC, Erben P, Oberneder R, Kriegmair M, Ritter M, Michel MS, Honeck P. Radical cystectomy under continuous antiplatelet therapy with acetylsalicylic acid. Eur J Surg Oncol 2019; 45:1260-1265. [PMID: 30827801 DOI: 10.1016/j.ejso.2019.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/08/2019] [Accepted: 02/17/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Aim of this study was to analyse the perioperative outcome of patients undergoing radical cystectomy under continuous antiplatelet therapy with acetylsalicylic acid. MATERIALS AND METHODS Using prospectively maintained databases of two departments of urology, we identified 461 consecutive patients who underwent radical cystectomy for bladder cancer (2011-2017). Patients were divided into three groups: 1) on-going antiplatelet therapy with acetylsalicylic acid (n = 50), 2) discontinuing antiplatelet therapy (n = 65) and 3) no antiplatelet therapy (n = 346). Perioperative outcome was compared between the three groups using ANOVA, likelihood ratio or Kruskal Wallis test with post-hoc testing. Uni- and multivariate analyses were performed to identify predictor for perioperative complications and transfusion. RESULTS Group 1 showed an average estimated blood loss of 732 ± 424, group 2 752 ± 488 and group 3 810 ± 544 ml (p = 0.51). There was no significant difference in transfusion rate (44% in group 1, 45% and 39% in groups 2 and 3, p = 0.63). Severe complications occurred in 26%, 15% and 15% in groups 1-3 (p = 0.19). Ischemic complications were more often observed in group 1 (n = 4, 8%) and 2 (n = 5, 8%) than group 3 (n = 7, 2%), p = 0.02. 90-day readmission (n = 99, 22%) and mortality rate (n = 10, 2.2%) were low and did not show any significant differences between the groups. In uni- and multivariate analysis ongoing therapy with acetylsalicylic acid was no independent risk factor for transfusion or severe complications. CONCLUSION Perioperative continuation of therapy with acetylsalicylic acid in radical cystectomy is safe with no difference in intraoperative blood loss, transfusion rate, complications or mortality.
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Affiliation(s)
- F Wessels
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - M C Kriegmair
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Oehme
- Clinic for Urology, Munich-Planegg, Germeringer Strasse, Germany
| | - M C Rassweiler-Seyfried
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Erben
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - R Oberneder
- Clinic for Urology, Munich-Planegg, Germeringer Strasse, Germany
| | - M Kriegmair
- Clinic for Urology, Munich-Planegg, Germeringer Strasse, Germany
| | - M Ritter
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M S Michel
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Honeck
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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11
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Nouhaud FX, Williams M, Arnfield E, Perera ML, Cho J, Esler R, Coughlin G. Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy? BJU Int 2018; 122 Suppl 5:15-21. [DOI: 10.1111/bju.14485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Michael Williams
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Evyn Arnfield
- Department of Radiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- School of Medicine; University of Queensland; Brisbane Qld Australia
| | - Marlon Lakmal Perera
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Jonathan Cho
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Rachel Esler
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- Wesley Urology Clinic; Wesley Hospital; Brisbane Qld Australia
| | - Geoff Coughlin
- Department of Radiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- Wesley Urology Clinic; Wesley Hospital; Brisbane Qld Australia
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12
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Chavali JSS, Bertolo R, Kara O, Garisto J, Mouracade P, Nelson RJ, Dagenais J, Kaouk JH. Renal Arterial Pseudoaneurysm After Partial Nephrectomy: Literature Review and Single-Center Analysis of Predictive Factors and Renal Functional Outcomes. J Laparoendosc Adv Surg Tech A 2018; 29:45-50. [PMID: 30300074 DOI: 10.1089/lap.2018.0364] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Partial nephrectomy (PN) represents the current surgical standard for T1 tumors. Renal arterial pseudoaneurysm is a rare but potentially life-threatening complication reported after PN. The aim of this study was to identify the factors associated with the occurrence of pseudoaneurysm after PN, specifically focusing on those requiring management with selective embolization. A literature review of the topic was performed. METHODS A retrospective review of the institutional PN database was performed from January 2011 to December 2016. Patients who underwent embolization for pseudoaneurysm represented a separated cohort to be compared with other patients (controls). Patients' and tumors' characteristics were considered. Univariable and multivariable analyses were used to test their eventual association with the occurrence of pseudoaneurysm. RESULTS A total of 1417 cases were evaluated. At a median of 21 days (interquartile range = 10-34), 20 patients (1.4%) developed postoperative pseudoaneurysm. The majority of patients (70%) presented with gross hematuria. The clinical suspicion was confirmed by contrast-enhanced computed tomography scan with angiography. Selective embolization was performed using endovascular coils. Technical success and clinical success rates were 100% and 95%, respectively. No difference was found in percentage estimated glomerular filtration rate (eGFR) preserved between patients who underwent embolization versus controls (median 82.6% versus 86.3%, P = .35). No differences in age, baseline renal function (as assessed by glomerular filtration rate [GFR]), tumor size, and R.E.N.A.L. were found between patients who reported and did not report pseudoaneurysm. In patients who developed pseudoaneurysm, longer operative time (225.6 minutes versus 193 minutes, P = .04), and cold ischemia time (48 minutes versus 29 minutes, P = .03) were reported. CONCLUSION In our series, the occurrence of pseudoaneurysm was associated with longer operative and cold ischemia times. In patients who underwent selective embolization, renal function remained comparable with that of controls.
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Affiliation(s)
- Jaya Sai S Chavali
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Riccardo Bertolo
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Onder Kara
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Juan Garisto
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Pascal Mouracade
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J Nelson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Julien Dagenais
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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13
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Pradere B, Peyronnet B, Khene ZE, Mathieu R, Verhoest G, Bensalah K. Simplified robot-assisted partial nephrectomy: step-by-step technique and perioperative outcomes. J Robot Surg 2018; 13:245-251. [PMID: 29982905 DOI: 10.1007/s11701-018-0845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/04/2018] [Indexed: 11/29/2022]
Abstract
Controversies have been raised and still exist regarding several technical aspects of robot-assisted partial nephrectomy (RAPN). While the "perfect RAPN" has still to be determined, we aimed to report a simplified technique of RAPN in a step-by-step fashion and the perioperative outcomes of a single-center series. A simplified technique of RAPN was developed, refined and standardized over the past 7 years in an academic department of urology to make it as safe and as reproducible as possible, the main goal being to make it an "easy to learn" technique for fellows. This technique is presented in 12 key steps. The patients' characteristics and perioperative outcomes were prospectively collected and are reported herein. Since the first case performed in our department in 2010, 406 patients have undergone RAPN with a standardized and stable simplified technique after the first 30 cases, involving several key steps including systematic use of the transperitoneal approach, minimal visceral mobilization of the colon, systematic psoas exposure and ureter identification, minimal dissection of the perinephric fat, arterial clamping with early unclamping, no use of hemostatic agents or drain. The majority of RAPN were performed by surgeons with either low experience (i.e., < 20 procedures; 46.3%) or intermediate experience (i.e., 20-50 procedures; 17.2%). The mean warm ischemia time was 15.3 min. Conversions to an open approach and to radical nephrectomy were required in 14 (3.5%) and 21 (5.2%) cases, respectively. From 132 patients who experienced post-operative complications (32.5%), 47 experienced a major complication (11.6%). The positive surgical margin rate was 5.6%. The simplified technique of RAPN was feasible and reproducible with satisfactory perioperative outcomes. Most of the key steps have been assessed through single-center and multicenter clinical studies.
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Affiliation(s)
- Benjamin Pradere
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Benoit Peyronnet
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Zine-Eddine Khene
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Romain Mathieu
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Gregory Verhoest
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Karim Bensalah
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
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