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

• Published in: Journal of experimental & clinical cancer research Vol. 33; no. 1; p. 63
• Main Authors: Sofra, Maria, Antenucci, Anna, Gallucci, Michele, Mandoj, Chiara, Papalia, Rocco, Claroni, Claudia, Monteferrante, Ilaria, Torregiani, Giulia, Gianaroli, Valeria, Sperduti, Isabella, Tomao, Luigi, Forastiere, Ester
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.08.2014; BioMed Central
• Subjects: Acquisitions & mergers; Aged; Anesthesia; Anesthesia, Inhalation - adverse effects; Anesthesia, Intravenous - adverse effects; Blood Coagulation Factors - metabolism; Blood Coagulation Tests; Blood platelets; Blood transfusions; Care and treatment; Drug therapy; Hemostasis; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - instrumentation; Male; Methods; Middle Aged; Patient outcomes; Postoperative period; Prostate cancer; Prostatectomy - adverse effects; Prostatectomy - instrumentation; Prostatectomy - methods; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Risk Factors; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - instrumentation; Robots; Rome; Studies; Surgery; Thrombosis; Thrombosis - blood; Thrombosis - diagnosis; Thrombosis - etiology; Time Factors; Treatment Outcome; Rome
• ISSN: 1756-9966; 0392-9078; 1756-9966
• DOI: 10.1186/s13046-014-0063-z

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. 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. 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. 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.