Skip to main content

Advertisement

SpringerLink
Log in

A comparative study of anticoagulant/antiplatelet therapy among men undergoing robot-assisted radical prostatectomy: a prospective single institution study

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

The present study aimed to assess the safety and efficacy of robot-assisted radical prostatectomy (RARP) in patients with prostate cancer (PCa) under anticoagulant (AC) and/or antiplatelet (AP) therapy, as compared to a control group, and to establish possible differences in postoperative-related morbidity. Data of all consecutive patients submitted to elective RARP for PCa from June 2017 to May 2020 at our institution were prospectively collected. Patients were divided according to the use of AC/AP therapy at surgery. The primary endpoint was to determine differences in 90-day postoperative complication rate, while secondary endpoints included differences in transfusion rate, readmission rate and postoperative oncological outcomes between the two groups. Sub-groups analysis was separately performed for patients undergoing pelvic lymphadenectomy and nerve-sparing procedures. Overall, 822 patients were included in the study and divided in 704 control-group patients (group A) and 118 patients under AC/AP therapy at surgery (group B). Despite the higher estimated blood loss between AC/AP takers and the control group, we did not find a significant difference in terms of 90-day postoperative complication rate, transfusion rate, readmission rate and postoperative oncological outcomes (all p > 0.05). In the cohort of patients undergoing nerve-sparing prostatectomy, a higher rate of complications and transfusions were found. At multivariate analysis, ASA score and ongoing medications were independently associated with complication in this sub-group. RARP can be safely and effectively performed in patients with PCa and ongoing AC/AP agents. Attention has to be paid in candidates for nerve-sparing procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mottet N, Bellmunt J, Briers E, Bolla M, Bourke L, Cornford P, et al. members of the EAU—ESTRO—ESUR—SIOG Prostate Cancer Guidelines Panel. EAU—ESTRO—ESUR—SIOG Guidelines on Prostate Cancer. Edn. Presented at the EAU Annual Congress 2021. 978-94-92671-07-3. Publisher: EAU Guidelines Office.

  2. Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L et al (2016) Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 388(10049):1057–1066

    Article  Google Scholar 

  3. Coughlin GD, Yaxley JW, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L et al (2018) Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol 19(8):1051–1060

    Article  Google Scholar 

  4. Gomez SL, Washington SL, Cheng I, Huang FW, Cooperberg MR (2021) Monitoring prostate cancer incidence trends: value of multiple imputation and delay adjustment to discern disparities in stage-specific trends. Eur Urol 79(1):42–43

    Article  Google Scholar 

  5. Pilleron S, Soto-Perez-de-Celis E, Vignat J, Ferlay J, Soerjomataram I, Bray F et al (2021) Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050. Int J Cancer 148(3):601–608

    Article  CAS  Google Scholar 

  6. Hutten BA, Prins MH, Gent M, Ginsberg J, Tijssen JG, Buller HR et al (2000) Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol 18:3078–3083

    Article  CAS  Google Scholar 

  7. Tikkinen KAO, Agarwal A, Craigie S, Cartwright R, Gould MK, Haukka J et al (2014) Systematic reviews of observational studies of risk of thrombosis and bleeding in urological surgery (ROTBUS): introduction and methodology. Syst Rev 23(3):150

    Article  Google Scholar 

  8. Naik R, Mandal I, Hampson A, Lane T, Adshead J, Rai BP et al (2019) The role of extended venous thromboembolism prophylaxis for major urological cancer operations. BJU Int 124(6):935–944

    Article  Google Scholar 

  9. Tikkinen KAO, Craigie S, Agarwal A, Siemieniuk RAC, Cartwright R, Violette PD et al (2018) Procedure-specific risks of thrombosis and bleeding in urological non-cancer surgery: systematic review and meta-analysis. Eur Urol 73(2):236–241

    Article  Google Scholar 

  10. Phillips J, Makarawo T, Abedin A, Shafik A, Eaton J, Makar A (2010) Extended venous thromboembolism prophylaxis after radical pelvic surgery for urological cancers. BJU Int 106:1110–1111

    Article  Google Scholar 

  11. Carneiro A, Cha JD, Baccaglini W, Husain FZ, Wroclawski ML, Nunes-Silva I et al (2019) Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis. Ther Adv Urol 8(11):1756287218816595

    Google Scholar 

  12. Oshima M, Washino S, Nakamura Y, Konishi T, Saito K, Arai Y et al (2020) 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. https://doi.org/10.1007/s11701-020-01154-8

    Article  PubMed  PubMed Central  Google Scholar 

  13. Carini M, Masieri L, Minervini A, Lapini A, Serni S (2008) Oncological and functional results of antegrade radical retropubic prostatectomy for the treatment of clinically localised prostate cancer. Eur Urol 53(3):554–561

    Article  Google Scholar 

  14. Gandaglia G, Ploussard G, Valerio M, Mattei A, Fiori C, Fossati N et al (2019) A novel nomogram to identify candidates for extended pelvic lymph node dissection among patients with clinically localized prostate cancer diagnosed with magnetic resonance imaging-targeted and systematic biopsies. Eur Urol 75(3):506–514

    Article  Google Scholar 

  15. Sforza S, Di Maida F, Mari A, Zaccaro C, Cini C, Tellini R et al (2019) Is a drainage placement still necessary after robotic reconstruction of the upper urinary tract in children? Experience from a tertiary referral center. J Laparoendosc Adv Surg Tech A 29(9):1180–1184

    Article  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  17. Tikkinen KAO, Cartwright R, Gould MK, Naspro R, Novara G, Sandset PM, et al. members of the EAU Thromboprophylaxis Guidelines Panel—EAU Guidelines on Thromboprophylaxis. Edn. Presented at the EAU Annual Congress Amsterdam 2020

  18. Violette PD, Cartwright R, Briel M, Tikkinen KAO, Guyatt GH (2016) Guideline of guidelines: thromboprophylaxis for urological surgery. BJU Int 118(3):351–358

    Article  Google Scholar 

  19. Culkin DJ, Exaire EJ, Green D, Soloway MS, Gross AJ, Desai MR et al (2014) Anticoagulation and antiplatelet therapy in urological practice: ICUD/AUA review paper. J Urol 192(4):1026–1034

    Article  Google Scholar 

  20. Pridgeon S, Allchorne P, Turner B, Peters J, Green J (2015) Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: a UK national audit. BJU Int 115(2):223–229

    Article  Google Scholar 

  21. Biondi-Zoccai GG, Lotrionte M, Agostoni P, Abbate A, Fusaro M, Burzotta F et al (2006) A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J 27(22):2667–2674

    Article  Google Scholar 

  22. Oscarsson A, Gupta A, Fredrikson M, Järhult J, Nyström M, Pettersson E et al (2010) To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth 104(3):305–312

    Article  CAS  Google Scholar 

  23. Weinberg A, Wright J, Deibert C, Lu YS, Hershman D, Neugut A et al (2014) Nationwide practice patterns for the use of venous thromboembolism prophylaxis among men undergoing radical prostatectomy. World J Urol 32(5):1313–1321

    Article  Google Scholar 

  24. Nik-Ahd F, Howard LE, Aronson WJ, Terris MK, Klaassen Z, Cooperberg MR et al (2020) Obese men undergoing radical prostatectomy: is robotic or retropubic better to limit positive surgical margins? Results from SEARCH. Int J Urol 27(10):851–857

    Article  Google Scholar 

  25. Leyh-Bannurah SR, Hansen J, Isbarn H, Steuber T, Tennstedt P, Michl U et al (2014) Open and robot-assisted radical retropubic prostatectomy in men receiving ongoing low-dose aspirin medication: revisiting an old paradigm? BJU Int 114(3):396–403

    CAS  PubMed  Google Scholar 

  26. Tyritzis SI, Wallerstedt A, Steineck G, Nyberg T, Hugosson J, Bjartell A et al (2015) Thromboembolic complications in 3544 patients undergoing radical prostatectomy with or without lymph node dissection. J Urol 193(1):117–125

    Article  Google Scholar 

  27. Sforza S, Tellini R, Grosso AA, Zaccaro C, Viola L, Di Maida F et al (2020) Can we predict the development of symptomatic lymphocele following robot-assisted radical prostatectomy and lymph node dissection? Results from a tertiary referral Centre. Scand J Urol 54(4):328–333

    Article  Google Scholar 

  28. Ng CF, Teoh JY, Chiu PK, Yee CH, Chan CK, Hou SS et al (2019) Robot-assisted single-port radical prostatectomy: a phase 1 clinical study. Int J Urol 26(9):878–883

    Article  Google Scholar 

  29. Jazayeri SB, Weissman B, Samadi DB (2018) Outcomes following robotic-assisted laparoscopic prostatectomy: pentafecta and trifecta achievements. Minerva Urol Nefrol 70(1):66–73

    PubMed  Google Scholar 

  30. Porcaro AB, Sebben M, Corsi P, Tafuri A, Processali T, Pirozzi M et al (2020) Risk factors of positive surgical margins after robot-assisted radical prostatectomy in high-volume center: results in 732 cases. J Robot Surg 14(1):167–175

    Article  Google Scholar 

  31. Masieri L, Sforza S, Di Maida F, Grosso AA, Mari A, Rosi EM et al (2019) Robotic correction of iatrogenic ureteral stricture: preliminary experience from a tertiary referral centre. Scand J Urol 53(5):356–360

    Article  CAS  Google Scholar 

Download references

Funding

None.

Author information

Author notes

  1. Simone Sforza and Antonio Andrea Grosso have equally contributed to the work.

Authors and Affiliations

  1. Department of Experimental and Clinical Medicine, University of Florence-Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Largo Brambilla, 3, 70134, Florence, Italy

    Simone Sforza, Antonio Andrea Grosso, Fabrizio Di Maida, Lorenzo Viola, Agostino Tuccio, Andrea Mari, Gianmartin Cito, Andrea Cocci, Marco Carini, Andrea Minervini & Lorenzo Masieri

Authors
  1. Simone Sforza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Andrea Grosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabrizio Di Maida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lorenzo Viola
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Agostino Tuccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea Mari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gianmartin Cito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrea Cocci
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marco Carini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Andrea Minervini
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Lorenzo Masieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simone Sforza.

Ethics declarations

Conflict of interest

The authors declare not to have potential conflict of interest.

Ethical approval

The research project has been approved by a suitably constituted Ethics Committee of the institution (protocol number FI10176). Informed consent was obtained for all individual participants included in the study from parents or legal guardians. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sforza, S., Grosso, A.A., Di Maida, F. et al. A comparative study of anticoagulant/antiplatelet therapy among men undergoing robot-assisted radical prostatectomy: a prospective single institution study. J Robotic Surg 16, 849–857 (2022). https://doi.org/10.1007/s11701-021-01308-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-021-01308-2

Keywords

Search

Navigation