title: Higher number of transrectal ultrasound guided prostate biopsy cores is associated with higher blood loss and perioperative complications in robot assisted radical prostatectomy.
abstract: BACKGROUND
  The local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy.
  
  
  OBJECTIVE
  To evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP).
  
  
  METHODS
  A prospectively maintained database of 2,054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications.
  
  
  RESULTS
  A total number of 1,042 patients in the group 1 (≤12 cores) and 1,012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; P=.03), but high grade complication (Clavien 3-4) were similar (G1 1.4 vs. G2 2.2%; P=.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; P=.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP.
  
  
  CONCLUSIONS
  Higher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results.
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia; Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brasil.
authors.forename: A
authors.initials: A
authors.lastname: Carneiro
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: A
authors.initials: A
authors.lastname: Sivaraman
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia. Electronic address: rafael.sanchez-salas@imm.fr.
authors.forename: R
authors.initials: R
authors.lastname: Sanchez-Salas
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: I
authors.initials: I
authors.lastname: Nunes-Silva
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: M
authors.initials: M
authors.lastname: Baghdadi
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: V
authors.initials: V
authors.lastname: Srougi
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: E
authors.initials: E
authors.lastname: di Trapani
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: F
authors.initials: F
authors.lastname: Uriburu Pizzaro
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: S
authors.initials: S
authors.lastname: Doizi
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: E
authors.initials: E
authors.lastname: Barret
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: F
authors.initials: F
authors.lastname: Rozet
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: M
authors.initials: M
authors.lastname: Galiano
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Paris, Francia.
authors.forename: X
authors.initials: X
authors.lastname: Cathelineau
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D006801:Humans; D061705:Image-Guided Biopsy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D065287:Robotic Surgical Procedures; D018084:Ultrasonography, Interventional
keywords: Biopsia prostática ecodirigida; Cáncer de próstata; Imaging-guided biopsy; Prostate cancer; Prostatectomía radical asistida por robot; Robot assisted radical prostatectomy