Büttner Thomas, Thudium Marcus O, Ritter Manuel, Hauser Stefan, Söhle Martin, Krausewitz Philipp
Department of Urology and Pediatric Urology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
J Robot Surg. 2025 Jul 22;19(1):413. doi: 10.1007/s11701-025-02579-9.
Robotic-assisted radical laparoscopic prostatectomy (RARP) is a standard treatment for localized prostate cancer. While surgical factors are often considered, the impact of anesthesiological factors, particularly intraoperative fluid management, on postoperative outcomes remains understudied. This study aimed to evaluate the relationship between fluid management and early complications after RARP. The study retrospectively analyzed data from 285 patients who underwent RARP at a single institution between 2019 and 2021. Fluid administration was quantified as corrected fluid dosage (mL/kg/h) and total fluid balance. Postoperative complications within 30 days, including anastomotic leakage and lymphocele formation, were assessed. Multivariable modeling and propensity score matching were used to evaluate the association between fluid management and lymphoceles. We found no significant association between fluid management and major complications (Clavien-Dindo grade ≥ II) or anastomotic leakage. However, a significant association was observed between higher fluid administration and lymphocele formation (p < 0.001). In the generalized linear model, the association of fluid dosage with lymphocele occurrence was confirmed (p = 0.002), independently of a peritoneal flap procedure. At a fluid dosage threshold of 7.73 ml/kg/h, propensity score matching confirmed the association. While major complications following RAPR are rare, generous fluid management was associated with a higher incidence of lymphocele formation. While these mostly remained asymptomatic, this finding suggests that intraoperative fluid management is a modifiable risk factor for lymphoceles and may prevent symptomatic lymphoceles as major complications in larger collectives. Moreover, it provides new insights into their potential pathogenesis.
机器人辅助腹腔镜根治性前列腺切除术（RARP）是局限性前列腺癌的标准治疗方法。虽然手术因素常被考虑，但麻醉因素，尤其是术中液体管理对术后结果的影响仍未得到充分研究。本研究旨在评估RARP术后液体管理与早期并发症之间的关系。该研究回顾性分析了2019年至2021年间在单一机构接受RARP的285例患者的数据。液体输注量以校正后的液体剂量（毫升/千克/小时）和总液体平衡来量化。评估了30天内的术后并发症，包括吻合口漏和淋巴囊肿形成。采用多变量建模和倾向评分匹配来评估液体管理与淋巴囊肿之间的关联。我们发现液体管理与主要并发症（Clavien-Dindo分级≥II级）或吻合口漏之间无显著关联。然而，观察到较高的液体输注量与淋巴囊肿形成之间存在显著关联（p < 0.001）。在广义线性模型中，证实了液体剂量与淋巴囊肿发生之间的关联（p = 0.002），且与腹膜瓣手术无关。在液体剂量阈值为7.73毫升/千克/小时时，倾向评分匹配证实了这种关联。虽然RARP术后的主要并发症很少见，但大量的液体管理与淋巴囊肿形成的发生率较高有关。虽然这些大多仍无症状，但这一发现表明术中液体管理是淋巴囊肿的一个可改变的危险因素，可能预防较大群体中作为主要并发症的有症状淋巴囊肿。此外，它为其潜在的发病机制提供了新的见解。
