ロボット支援前立腺摘除術（RALP）後の出血性および血栓性合併症とリスク適応型抗血栓予防：後向き研究

Despite advances in robotic-assisted prostatectomy and enhanced postoperative rehabilitation protocols, approximately 20% of patients still experience complications-most frequently hemorrhagic. To evaluate the effect of discontinuing systematic PAP (pharmacologic anticoagulant prophylaxis) on postoperative complications-specifically hemorrhagic and thrombotic events-after robotic-assisted prostatectomy.

In this retrospective before-and-after study, 361 consecutive patients undergoing prostatectomy at a single center were included. Group I (n=173) received systematic PAP with low molecular weight heparin for 28 days postoperatively, alongside routine physical prophylaxis (early mobilization, adequate hydration, and intraoperative leg compression). Group II (n=188) received only routine physical prophylaxis.The primary endpoints were hemorrhagic and thrombotic complications.

Clavien-Dindo ≥ II complications were significantly more frequent in Group I (20.2%) compared to Group II (12.2%, p < 0.05). Hemorrhagic complications occurred in 10% of patients overall, with a significantly higher rate in Group I (15.0% vs. 3.7%, p<0,05). Thrombotic events were rare in both groups and not statistically different 2,3% vs 3,7% (p=0,3). Thrombotic risk did not show a statistically significant difference in adjusted models with propensity score methods.

Our study suggest that systematic anticoagulation may increase hemorrhagic morbidity without a clear thrombotic benefit. These findings support a risk-adapted, individualized approach rather than routine pharmacologic thromboprophylaxis.