BERKELEY, CA (UroToday.com) - It is a commonly held notion that patients with end stage renal disease and prostate cancer are not considered surgical candidates for prostate removal due to associated comorbidities.
Our retrospective study demonstrates that robotic assisted laparoscopic prostatectomy is a safe and efficacious procedure in this patient population. In this study we compared the outcomes of 12 robotic radical prostatectomies performed in patients with renal failure with 418 patients with normal renal function. Although statistically the ESRD group was younger, had higher serum creatinine, lower starting hemoglobin, higher ASA scores, and a higher Charlson Comorbidity Index there was no statistical difference when compared to the control group with regards to estimated blood loss, operative time, complications and duration of hospital stay.
We feel that the robotic platform lends itself particularly well to the renal failure patient with prostate cancer. Renal failure patients do not tolerate fluid shifts well and electrolyte abnormalities and fluid shifts are one major source of complications in these patients. With robotic radical prostatectomy the blood loss is usually very minimal even in patients in ESRD. Using an immaculate surgical technique, despite dysfunctional platelets our mean blood loss was only 95.8 cc. This also allowed us to run the patients very dry and there were no episodes of CHF and no blood transfusions in the ESRD population. Renal failure patients also are at risk for surgical infections, but the small incisions of robotic prostatectomy are less likely to result in infection compared to open surgery.
Perhaps the most important finding is that all ESRD patients had undetectable PSA levels using an ultrasensitive assay following surgery. This is particularly important because these patients are unlikely to die of prostate cancer but are very likely to die of renal failure if they do not proceed to transplant. Hence, the robotic prostatectomy renders the patients free of cancer and in our institution if the PSA remains undetectable and the margins are negative we are currently clearing these patients for transplant after a relatively short 6-12 month interval.
This study provides compelling evidence that definitive surgical management can be safely performed in this patient population as it is in the general population. Certainly the careful preoperative evaluation, immaculate surgical technique and a multidisciplinary approach are required to deal with these very complicated patients. The success of robotic surgery in renal failure patients will need to be studied long-term in other centers to fully understand the outcomes in these difficult patients
Written by:
D. Duane Baldwin, MD., Et Al. as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Robot-assisted radical prostatectomy in patients with previous renal transplantation - Abstract
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