Department of Urology, New York University School of Medicine NYU, New York, NY, USA.
BJU Int. 2012 Jul;110(1):69-75. doi: 10.1111/j.1464-410X.2011.10812.x. Epub 2011 Dec 7.
Study Type - Outcomes (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? It is generally accepted in the medical community that total and intra-operative blood loss after RALP is significantly lower in comparison with ORRP. This has led to speculation that less bleeding results in better visualization of the operative field resulting in superior potency and continence. Blood loss (BL) during ORRP does not adversely impact clinical and functional outcomes irrespective of how BL is defined. Thus, the lower BL associated with RALP would not be expected to improve functional or oncological outcomes.
To determine the short- and long-term impact of blood loss (BL) on clinical, oncological and functional outcomes as well as complication rates after an open radical retropubic prostatectomy (ORRP).
Between 2000 and 2008, 1567 men who underwent an ORRP participated in our prospective longitudinal outcomes study. Haematocrit (Hct) levels, transfusion rates, BL and complications were recorded prospectively. Validated, self-administered quality-of-life (QoL) questionnaires were completed at baseline, 3, 6 and 12 months and yearly thereafter. Urinary function and erectile dysfunction were assessed using AUA Symptom Score and the UCLA Prostate Cancer Index and analysis of variance (anova)/chi-square tests were used to compare clinical, BL, biochemical recurrence (BCR) and QoL outcomes amongst the three groups for continuous/categorical variables.
The mean estimated BL was 742.7 (45 to 3500) mL and 5.4% and 3.8% received an autologous (AU) or allogeneic (AL) blood transfusions, respectively. The average baseline, induction, postoperative and discharge Hct was 43.8%, 48.3%, 35.7% and 34.1%, respectively. The estimated BL and the rate of change of Hct correlated moderately (r=0.41, P<0.0001). Tertiles of BL were based on the difference between induction and discharge Hct (Delta 1) and the average Delta 1 for Groups 1, 2 and 3 were 7.9%, 12.7% and 17.2%, respectively. Intra-operative, early/delayed complications, length of hospital stay (LoS), SM surgical margins status, anastomotic stricture and BCR were not statistically different (P<0.001) and the mean AUASS, UCLA Prostate Cancer urinary bother scores, urinary function scores, sexual bother/function scores at 24 months were similar amongst all tertiles (P>0.05).
BL during ORRP does not adversely impact clinical and functional outcomes irrespective of how BL is defined. Thus, the lower BL associated with robotic-assisted laparoscopic prostatectomy (RALP) in and of itself would not be expected to improve functional or oncological outcomes.
确定失血量（BL）对临床、肿瘤学和功能结果以及开放根治性前列腺切除术（ORRP）后并发症发生率的短期和长期影响。
在 2000 年至 2008 年间，有 1567 名男性接受了 ORRP，并参与了我们的前瞻性纵向结果研究。前瞻性记录血细胞比容（Hct）水平、输血率、BL 和并发症。在基线、3、6 和 12 个月以及此后每年完成有效的、自我管理的生活质量（QoL）问卷。使用 AUA 症状评分和 UCLA 前列腺癌指数评估尿功能和勃起功能障碍，并使用方差分析（anova）/卡方检验比较三组患者的临床、BL、生化复发（BCR）和 QoL 结果。
平均估计 BL 为 742.7（45 至 3500）ml，分别有 5.4%和 3.8%接受了自体（AU）或同种异体（AL）输血。平均基线、诱导、术后和出院 Hct 分别为 43.8%、48.3%、35.7%和 34.1%。估计的 BL 和 Hct 的变化率中度相关（r=0.41，P<0.0001）。BL 的三分位数基于诱导和出院 Hct 之间的差异（Delta 1），并且 Group 1、2 和 3 的平均 Delta 1 分别为 7.9%、12.7%和 17.2%。术中、早期/延迟并发症、住院时间（LoS）、SM 手术切缘状态、吻合口狭窄和 BCR 无统计学差异（P<0.001），所有三分位数的平均 AUASS、UCLA 前列腺癌尿困扰评分、尿功能评分、24 个月时的性困扰/功能评分均相似（P>0.05）。
无论如何定义 BL，ORRP 期间的 BL 都不会对临床和功能结果产生不利影响。因此，与机器人辅助腹腔镜前列腺切除术（RALP）相关的较低 BL 本身不会改善功能或肿瘤学结果。
