title: Blood loss during radical prostatectomy: impact on clinical, oncological and functional outcomes and complication rates.
abstract: 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.
  
  
  OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, New York University School of Medicine NYU, New York, NY, USA. bdjavan@hotmail.com
authors.forename: Bob
authors.initials: B
authors.lastname: Djavan
authors.forename: Ilir
authors.initials: I
authors.lastname: Agalliu
authors.forename: Juliana
authors.initials: J
authors.lastname: Laze
authors.forename: Helen
authors.initials: H
authors.lastname: Sadri
authors.forename: Amir
authors.initials: A
authors.lastname: Kazzazi
authors.forename: Herbert
authors.initials: H
authors.lastname: Lepor
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D007172:Erectile Dysfunction / Q000209:etiology; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects; D011788:Quality of Life; D014549:Urinary Incontinence / Q000209:etiology