Comparison of incidence of acute kidney injury after robot-assisted radical prostatectomy with that after open retropubic and extraperitoneal laparoscopic radical prostatectomies in patients with prostate cancer

Abstract

Background: We retrospectively evaluated the postoperative renal function in patients who had undergone radical prostatectomy to compare the incidences of postoperative acute kidney injury (AKI) among the patients who had undergone robot-assisted radical prostatectomy (RARP), retropubic radical prostatectomy (RRP), and extraperitoneal laparoscopic radical prostatectomy (exLRP).

Materials and methods: Patients with prostate cancer who had undergone radical prostatectomy at our institution between 2008 and 2014 were included. Robot-assisted radical prostatectomy was performed using an intraperitoneal approach in a 25-degree Trendelenburg position, whereas other procedures were performed with the patient in the supine position. We evaluated the serum creatinine levels and estimated glomerular filtration rates immediately after surgery and on postoperative day 1. We evaluated the incidence of AKI after prostatectomy using the Acute Kidney Injury Network criteria of the Kidney Disease: Improving Global Outcomes guidelines.

Results: A total of 150 consecutive patients were included, with each of the 3 groups (RARP, RRP, and exLRP) comprising 50 patients. Postoperative AKI was observed in 15 (30.0%), 1 (2.0%), and 3 (6.0%) patients in the RARP, RRP, and exLRP groups, respectively. Stage 1 AKI was observed in all the patients except one. The incidence of AKI in RARP group was significantly higher than that in the other groups (p < 0.001). In the RARP group, the serum creatinine level was significantly elevated immediately after the surgery; however, it returned to baseline on postoperative day 1. Surgical procedures were the only independent factor associated with AKI incidence.

Conclusions: This study suggest that compared with RRP and exLRP, RARP is associated with a higher incidence of postoperative AKI, although most patients recover rapidly. Intra-abdominal pneumoperitoneum may contribute to AKI onset.

Keywords

Acute kidney injury / Renal function / Prostatectomy

Acknowledgments

The authors thank Mr Kim Barrymore for improving the language used in the manuscript.

Statement of ethics

This study was approved by the institutional research committee of the institution at which the study was conducted (Sapporo Medical University no. 342-57). Because this was an observational and not a prospective intervention study, the ethics committee waived the need for written informed consent. We announced the commencement of this study on our Web site (http://web.sapmed.ac.jp/uro/) with the proviso that participants could withdraw later. All procedures involving human participants were performed in accordance with the ethical standards of the institutional research committee of the institution at which the study was conducted (Sapporo Medical University no. 342-57) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

No conflict of interest has been declared by the author.

Funding source

None.

Author contributions

SS: Participated in research, data analysis, and writing the manuscript;TT: Participated in data analysis and writing the manuscript;TM: Participated in research design and data analysis;KH, KK: Participated in data analysis;NM: Supervised the research and participated in writing the manuscript.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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