title: Perioperative changes in pro and anticoagulant factors in prostate cancer patients undergoing laparoscopic and robotic radical prostatectomy with different anaesthetic techniques.
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.
authors.affiliation: Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. sofra@ifo.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Sofra
authors.affiliation: Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy. antenucci@ifo.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Antenucci
authors.affiliation: Department of Urology, Regina Elena, Roma National Cancer Institute, Rome, Italy. gallucci@ifo.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Gallucci
authors.affiliation: Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy. conti@ifo.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mandoj
authors.affiliation: Department of Urology, Regina Elena, Roma National Cancer Institute, Rome, Italy. mpurri@yahoo.it.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.affiliation: Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. clacla@fastwebnet.itt.
authors.forename: Claudia
authors.initials: C
authors.lastname: Claroni
authors.affiliation: Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. Monteferrante@ifo.it.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Monteferrante
authors.affiliation: Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. giulia.torregiani@tin.it.
authors.forename: Giulia
authors.initials: G
authors.lastname: Torregiani
authors.affiliation: Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. v.gianaroli@gmail.com.
authors.forename: Valeria
authors.initials: V
authors.lastname: Gianaroli
authors.affiliation: Division of Biostatistic, Regina Elena, Roma National Cancer Institute, Rome, Italy. sperduti@ifo.it.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.affiliation: Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy. luigi.tomao@gmail.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tomao
authors.affiliation: Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy. forastiere@ifo.it.
authors.forename: Ester
authors.initials: E
authors.lastname: Forastiere
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation / Q000009:adverse effects*; D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000378:metabolism*; D001780:Blood Coagulation Tests; D006487:Hemostasis; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D012384:Rome; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001779:Blood Coagulation Factors