Estimated Blood Loss as a Predictor of Postoperative Continence and Oncologic Outcomes in Robot-Assisted Radical...

This study aimed to evaluate the relationship of perioperative estimated blood loss (EBL) with peri- and postoperative parameters during the robot-assisted radical prostatectomy (RARP) procedure.

In this retrospective study, data from patients with localized prostate cancer (PCa) who underwent RARP between December 2012 and August 2024 (n = 530) were analyzed. Patients with EBL of 100 ml or less were defined as group 1 (n = 359), and those with EBL exceeding 100 ml were defined as group 2 (n = 166). Perioperative data and postoperative functional and pathologic outcomes were recorded and compared between the two groups.

The patients in group 2 had longer lymph node dissection time, prostatectomy time, anastomosis time, total operation time, drain removal time, and hospital stay, as well a greater EBL, higher surgical margin ratio, greater positive surgical margin according to pathologic stage, and longer time to reach continence (p = 0.001). No difference was observed between urinary incontinence (UI) scores at the sixth month postoperatively (p = 0.191). A high degree of correlation was observed between EBL and other parameters (drain removal time, hospital length of stay, time to reach continence, prostatectomy time, International Consultation on Incontinence Questionnaire [ICIQ] total score at the first and third months, and total operation and anastomosis time, respectively; rho-factor ≥ 0.5; p < 0.05). In the multivariate regression analysis, EBL was determined to be a predictive factor for achieving postoperative urinary continence.

The study demonstrated that perioperative EBL is associated with postoperative urinary continence and oncologic outcomes after RARP.