Maria Sofra1, Anna Antenucci2, Michele Gallucci3, Chiara Mandoj4, Rocco Papalia5, Claudia Claroni6, Ilaria Monteferrante7, Giulia Torregiani8, Valeria Gianaroli9, Isabella Sperduti10, Luigi Tomao11, Ester Forastiere12. 1. Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. sofra@ifo.it. 2. Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy. antenucci@ifo.it. 3. Department of Urology, Regina Elena, Roma National Cancer Institute, Rome, Italy. gallucci@ifo.it. 4. Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy. conti@ifo.it. 5. Department of Urology, Regina Elena, Roma National Cancer Institute, Rome, Italy. mpurri@yahoo.it. 6. Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. clacla@fastwebnet.itt. 7. Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. Monteferrante@ifo.it. 8. Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. giulia.torregiani@tin.it. 9. Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. v.gianaroli@gmail.com. 10. Division of Biostatistic, Regina Elena, Roma National Cancer Institute, Rome, Italy. sperduti@ifo.it. 11. Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy. luigi.tomao@gmail.com. 12. Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. forastiere@ifo.it.
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.
RCT Entities:
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 BALpatients 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 cancerpatients undergoing LRP, mainly when the robotic device was utilized, encouraging the use of a peri-operative thromboembolic prophylaxis in these patients.
Authors: S Nozuchi; T Mizobe; H Aoki; N Hiramatsu; K Kageyama; F Amaya; K Uemura; T Fujimiya Journal: Anesthesiology Date: 2000-01 Impact factor: 7.892
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Authors: H Hirakata; F Ushikubi; H Toda; K Nakamura; S Sai; N Urabe; Y Hatano; S Narumiya; K Mori Journal: Anesthesiology Date: 1996-12 Impact factor: 7.892
Authors: Roberta Merola; Luigi Tomao; Anna Antenucci; Isabella Sperduti; Steno Sentinelli; Serena Masi; Chiara Mandoj; Giulia Orlandi; Rocco Papalia; Salvatore Guaglianone; Manuela Costantini; Giuseppe Cusumano; Giovanni Cigliana; Paolo Ascenzi; Michele Gallucci; Laura Conti Journal: J Exp Clin Cancer Res Date: 2015-02-06