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Marcon J, Bischoff R, Rattenhuber K, Chaloupka M, Askari D, Jokisch JF, Becker AJ, Pfitzinger PL, Keller P, Berg E, Stief CG, Siegl D, Kowalski C, Buchner A, Pyrgidis N, Weinhold P. Impact of Intraoperative Opioid Use and a Combined Anesthesia Regimen in Patients Undergoing Radical Prostatectomy for Prostate Cancer in a Single-Center Cohort. J Clin Med 2024; 13:7506. [PMID: 39768429 PMCID: PMC11677334 DOI: 10.3390/jcm13247506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 12/02/2024] [Accepted: 12/09/2024] [Indexed: 01/11/2025] Open
Abstract
Introduction: Higher intraoperative opioid doses may be associated with worse long-term oncological outcomes after radical prostatectomy (RP) for prostate cancer. We aimed to evaluate the impact of higher doses of intraoperative opioids and type of anesthesia on biochemical recurrence (BCR) and mortality after RP in a high-volume tertiary center. Methods: All patients underwent RP at our center between 2015 and 2021. The role of major intraoperative opioid agents, such as sufentanil remifentanil, and morphine milligram equivalents (MMEs), as well as the type of anesthesia [total intravenous anesthesia (TIVA), versus a combination of TIVA and epidural anesthesia, versus solely epidural anesthesia], was assessed in predicting BCR and survival after RP. Results: A total of 1137 patients who had a median age of 66 years (interquartile range: 61-72) were included. Overall, 1062 (93%) patients received TIVA, 37 (3%) received TIVA and epidural anesthesia, and 41 (4%) only epidural anesthesia. At a median follow-up of 431 days (interquartile range: 381-639) from RP, 257 (24%) patients developed a BCR. Accordingly, at a median follow-up of 500 days (interquartile range: 450-750), 33 (2.9%) patients died. The type of anesthesia, as well as the dosage or type of the selected intraoperative opioid agents, did not affect either BCR or long-term overall survival. Conclusions: These findings suggest that intraoperative opioid application during RP has no negative oncological impact in the short and long term in patients with localized prostate cancer. Accordingly, combined TIVA and epidural anesthesia, as well as solely epidural anesthesia were associated with similar short- and long-term outcomes compared to TIVA.
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Affiliation(s)
- Julian Marcon
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Robert Bischoff
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Kaspar Rattenhuber
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Michael Chaloupka
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Darjusch Askari
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Jan-Friedrich Jokisch
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Armin J. Becker
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Paulo L. Pfitzinger
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Patrick Keller
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Elena Berg
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Christian G. Stief
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Daniel Siegl
- Department of Anesthesiology, University Hospital of the LMU Munich, 81377 Munich, Germany; (D.S.); (C.K.)
| | - Christian Kowalski
- Department of Anesthesiology, University Hospital of the LMU Munich, 81377 Munich, Germany; (D.S.); (C.K.)
| | - Alexander Buchner
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
| | - Philipp Weinhold
- Department of Urology, University Hospital of the LMU Munich, 81377 Munich, Germany; (J.M.); (R.B.); (K.R.); (M.C.); (D.A.); (J.-F.J.); (A.J.B.); (P.L.P.); (P.K.); (E.B.); (C.G.S.); (P.W.)
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Blanco S, Grasso A, Sulmina E, Grasso M. Effectiveness and safety of spinal anesthesia in patients undergoing open radical retropubic prostatectomy. Arch Ital Urol Androl 2023:11281. [PMID: 37254925 DOI: 10.4081/aiua.2023.11281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE Prostate cancer is one of the most widespread neoplasms affecting the male gender. The most commonly used procedures in various urological centers are laparoscopic and robotic surgery because they are considered minimally invasive techniques. We present our experience in traditional open radical prostatectomy performed under spinal anesthesia. MATERIALS AND METHODS We reviewed the clinical courses of 88 consecutive patients who underwent open radical prostatectomy performed under spinal anesthesia at our Institution. RESULTS Median age: 67.7 years. Median follow up duration: 48 months. Median pre-operative PSA: 15,9 ng/ml, median Prostate weight: 44.5 gr, median surgical time: 96.5 minutes (range 55-138). Perioperative complications were recorded. The most frequent complication was anemia, 9 cases need blood transfusion after surgery. Complications directly related to spinal anesthesia were not observed. Most patients were discharged within 5 days from the procedure. After two weeks we observed a quick recovery of total continence in 90% of patients. After 6 months all patients were perfectly continent. Erectile dysfunction after 6 months was reported by 48 patients. CONCLUSIONS The reasons why the gold standard of radical prostatectomy surgery has been considered general anesthesia are essentially two: the long duration of the surgical procedure and the associated significant blood loss. Multiple evidences show that radical retropubic prostatectomy can be safely performed under spinal anaesthesia with various advantages. It is therefore no longer justified to consider general anesthesia as the gold standard for radical prostatectomy with an open technique.
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Affiliation(s)
- Salvatore Blanco
- Department of Urology, Fondazione IRCCS San Gerardo dei Tintori, Monza.
| | - Angelica Grasso
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan.
| | - Endrit Sulmina
- Department of Anesthesia and Intensive Care Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza.
| | - Marco Grasso
- Department of Urology, Fondazione IRCCS San Gerardo dei Tintori, Monza.
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Pikramenos K, Zachou M, Apostolatou E, Papadopoulos D, Mitsogianni M, Papatsoris A, Varkarakis I, Mitsogiannis I. The effects of method of anaesthesia on the safety and effectiveness of Radical Retropubic Prostatectomy. Arch Ital Urol Androl 2022; 94:396-400. [PMID: 36576466 DOI: 10.4081/aiua.2022.4.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine if patients undergoing radical retropubic prostatectomy with localized prostate cancer under combined (epidural-spinal) anaesthesia have any benefit over patients undergoing the procedure under general anaesthesia. MATERIAL AND METHODS Patients with clinically localised prostate cancer, scheduled for radical retropubic prostatectomy, were allocated to undergo the operation under either general anaesthesia (GA) or under combined (epidural-spinal) (CESA) anaesthesia. Several parameters were recorded both preoperatively (medical history, biometric data, PSA, biopsy Gleason score) and postoperatively (blood pressure, heart rate, haemoglobin levels, operation time and total hospital stay). In addition, mean arterial pressure, change in heart rate, total blood loss, blood transfusions, SAS score, intravenous fluid administration and operation time were also noted down intraoperatively. Patient pain levels and total satisfaction were evaluated using appropriate questionnaires. At the 12-month follow-up, biochemical recurrence using PSA levels and urinary continence status were evaluated. RESULTS A total of 60 patients were included (30 in each group). Intraoperatively, mean MAP and heart rate change was higher in the GA group (MAP+7,46, HR+27) and mean SAS was higher in the CESA group (+0.93). The time needed for patients' recovery was faster (-3.5 min) and hospitalization was shorter for patients in the CESA group (-0.6 days). Intraoperative blood loss, time for induction and duration of operation were not significantly different. Mean postoperative drop of haemoglobin was greater in the GA group (+0.56) while blood transfusions, VAS pain scores and amount of intravenous fluids did not differ significantly between the two groups. No complications were reported. Patient satisfaction and urinary continence were comparable between the groups and there were no cases of biochemical recurrence. CONCLUSIONS Radical retropubic prostatectomy can safely be performed under combined (spinal epidural anaesthesia, with possible benefits of lower blood loss, less post-operative complications and earlier discharge. Both procedures have equal oncological and functional outcomes at the 12-month follow-up.
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Affiliation(s)
- Konstantinos Pikramenos
- 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens.
| | - Maria Zachou
- Gastroenterology Department, Sismanoglio Hospital, Athens.
| | - Eleftheria Apostolatou
- 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens.
| | - Dimitrios Papadopoulos
- Anaesthesiology Department, Evgenidio Hospital, National and Kapodistrian University of Athens.
| | | | - Athanasios Papatsoris
- 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens.
| | - Ioannis Varkarakis
- 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens.
| | - Iraklis Mitsogiannis
- 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens.
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Alba S, Fimognari D, Crocerossa F, Ascalone L, Pullano C, Chiaravalloti F, Chiaradia F, Carbonara U, Ferro M, de Cobelli O, Pagliarulo V, Lucarelli G, Battaglia M, Damiano R, Cantiello F. Neuraxial anesthesia versus general anesthesia in patients undergoing three-dimensional laparoscopic radical prostatectomy: Preliminary results of a prospective comparative study. Asian J Urol 2022. [PMID: 37538165 PMCID: PMC10394281 DOI: 10.1016/j.ajur.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective Neuraxial anesthesia (NA) showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery. We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy (t-3DLRP) and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia (GA). Methods A prospective, double-center, double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed. A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA. Results The two group were similar in all demographic, clinical, and pathological variables. Postoperative blood gas parameters were within physiologic limits in both groups. Muscle relaxation was adequate for surgery during both NA and GA. Median length of stay was 1 day shorter for NA group than GA group (5 days vs. 6 days, p=0.05). t-3DLRP under NA had a statistically lower rate of minor complications (4.8% vs. 19.0%, p=0.03) and less postoperative pain (median numeric rating scale 3 vs. 4, p=0.01) compared to GA. No major complications were observed in both groups. Significantly more patients were willing to undergo a similar intervention under NA than GA (p=0.04). Conclusion t-3DLRP under NA is a feasible and safe procedure, with less postoperative pain and fewer minor complications than the same procedure under GA. NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.
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Devana SK, Chaudhary K, Sharma AP, Singh SK. Changing urological practice during COVID-19. Indian J Urol 2020; 36:153-158. [PMID: 33082628 PMCID: PMC7531373 DOI: 10.4103/iju.iju_269_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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