As such, in the latest issue of the Journal of Robotic Surgery, my colleagues and I shared the results of a study comparing the outcomes of a cohort of patients submitted to RARP for first-diagnosticated prostate cancer grouped with on-going anticoagulant (AC)/antiplatelet (AP) therapies with a control group.1
Our study design included a prospectively gathering of data and precise handling of AC/AP therapies following the standard European guidelines. Overall, data of 822 patients were analyzed and grouped in 118 patients under AC/AP therapy at surgery and 704 control-group cases.
Based on our study, a few clear pieces of evidence emerged:
- No significant differences in terms of overall complication rate (17.8% vs 14.8%), transfusion rate (2.5% vs 2.4%), and readmission rate (1.7% vs 3.6%) between the two groups (p>0.05) were recorded, although a higher median estimated blood loss in the study group.
- No difference resulted with respect to oncological outcomes, as positive surgical margin and detectable postoperative PSA rate, showing that, despite the possible surgical difficulties caused by the more likely bleeding among ACs/APs consumers, this did not translate into detrimental oncological safety in this group of patients.
- At the sub-group analysis, patients submitted to nerve-sparing RARP with on-going AC/AP therapy showed a higher 90-days complications rate as compared to their counterparts among the control group. This result was confirmed at the multivariate analysis, where AC/AP maintenance emerged as an independent predictor of complications only in this specific sub-group of patients.
We believe that robotic assistance has substantially determined these three results. In fact, through coordinated traction using the three robotic harms with the paramount support of the 3D vision and an ergonomic position, the prostate dissection can be conducted even in challenging conditions as the one possibly detectable in patients under ACs/APs allowing to maintain optimal postoperative outcomes in the vast majority of cases, as previous evidence suggested.2,3
All this evidence together significantly supports continuing prophylaxis medications in the vast majority of patients undergoing elective RARP, with the exception of frail patients amenable to neurovascular bundle preservation.
Written by: Simone Sforza,1 Antonio Andrea Grosso,1 Andrea Minervini,1 Lorenzo Masieri1
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
References:
- Sforza S, Grosso AA, Di Maida F, Viola L, Tuccio A, Mari A, Cito G, Cocci A, Carini M, Minervini A, Masieri L. A comparative study of anticoagulant/antiplatelet therapy among men undergoing robot-assisted radical prostatectomy: a prospective single institution study. J Robot Surg. 2021 Sep 21. doi: 10.1007/s11701-021-01308-2. Epub ahead of print. PMID: 34546522.
- Sforza S, Tellini R, Grosso AA, Zaccaro C, Viola L, Di Maida F, Mari A, Carini M, Minervini A, Masieri L. 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. 2020 Aug;54(4):328-333. doi: 10.1080/21681805.2020.1784270. Epub 2020 Jun 26. PMID: 32588704.
- Masieri L, Sforza S, Di Maida F, Grosso AA, Mari A, Rosi EM, Tellini R, Carini M, Minervini A. Robotic correction of iatrogenic ureteral stricture: preliminary experience from a tertiary referral centre. Scand J Urol. 2019 Oct;53(5):356-360. doi: 10.1080/21681805.2019.1651390. Epub 2019 Aug 30. PMID: 31469016.
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