Perioperative changes in pro and anticoagulant factors in prostate cancer patients undergoing laparoscopic and robotic radical prostatectomy with different anaesthetic techniques

Maria Sofra, Anna Antenucci, Michele Gallucci, Chiara Mandoj, Rocco Papalia, Claudia Claroni, Ilaria Monteferrante, Giulia Torregiani, Valeria Gianaroli, Isabella Sperduti, Luigi Tomao, Ester Forastiere, Maria Sofra, Anna Antenucci, Michele Gallucci, Chiara Mandoj, Rocco Papalia, Claudia Claroni, Ilaria Monteferrante, Giulia Torregiani, Valeria Gianaroli, Isabella Sperduti, Luigi Tomao, Ester Forastiere

Abstract

Background: Laparoscopic prostatectomy (LRP) may activate clotting system influencing the risk of perioperative thrombosis in patients with prostate cancer. Moreover, different anaesthetic techniques can also modify coagulant factors. Thus, the aim of this study was to investigate the effects on pro- and anti-coagulant and fibrinolytic factors of two established types of anaesthesia in patients with prostate cancer undergoing elective LRP.

Methods: 102 patients with primary prostate cancer, who underwent conventional LRP or robot-assisted laparoscopic prostatectomy (RALP), were studied and divided into 2 groups to receive total intravenous anesthesia with target-controlled infusion (TIVA-TCI) or balanced inhalation anaesthesia (BAL) prior to surgery. Before the induction of anaesthesia (T0), 1 hr (T1) and 24 hrs post-surgery (T2), some pro-coagulant factors, fibronolysis markers, p-selectin and haemostatic system inhibitors were evaluated.

Results: Both TIVA-TCI and BAL patients showed a marked and significant increase in pro-coagulant factors and consequent reduction in haemostatic system inhibitors in the early post operative period (p ≤ 0.004 for each markers). Use of RALP showed a significant increase in prothrombotic markers as compared to LRP. In TIVA patients undergoing LRP, a significant reduction of p-selectin levels between T0 and T2 (p = 0.001) was observed as compared to BAL, suggesting a better protective effect on platelet activation of anaesthetic agents used for TIVA.

Conclusions: Both anaesthetic techniques significantly seem to increase the risk of thrombosis in prostate cancer patients undergoing LRP, mainly when the robotic device was utilized, encouraging the use of a peri-operative thromboembolic prophylaxis in these patients.

Trial registration: ClinicalTrials.gov NCT01998685.

Figures

Figure 1
Figure 1
Coagulation cascade. The solid lines indicate a activating function, while the dashed lines a inhibitory action.
Figure 2
Figure 2
Design of the study: patient selection.
Figure 3
Figure 3
Changes of p-selectin levels between T0 (before the induction of anaesthesia) and T2 (24 hrs post-surgery) in patients undergoing conventional laparoscopic radical prostatectomy (LRP) or robot-assisted laparoscopic prostatectomy (RALP). TIVA-TCI patients undergoing LRP showed a significant reduction in p-selectin levels between T0 and T2 (p?=?0.001) while no changes were observed in the BAL group. In contrast, a significant increase of p-selectin value was observed 24 hours after surgery (T2) in patients undergoing RALP, regardless of the type of anaesthesia.

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