Radikal Robotik Prostatektomi Uygulanan Hastalarda Nötrofil / Lenfosit Oranının İntraoperatif Asidoz Gelişimi ve Hastanede Yatış Süresine Etkisinin Retrospektif İncelenmesi

Öz

Amaç: Bu çalışmada, robotik yardımlı radikal prostatektomi prosedürü uygulanan hastalarda, nötrofilin lenfosit oranının NLR intraoperatif asidoz ve postoperatif hastanede kalış süresi için öngörü değeri araştırıldı.Gereç ve Yöntemler: Lokal ileri prostat kanseri olan ve elektif robotik destekli radikal prostatektomi prosedürü uygulanan hastalar çalışmaya dahil edildi. Hastalar ASA I-II sınıfında ve nöromusküler bloğu revers etmek için sugammadeks kullanıldı. Perioperatif tam kan sayımı ve kan gazı analizi yapıldı. Nötrofil lenfosit oranı, nötrofil sayılarının lenfosit sayılarına bölünmesiyle hesaplandı. Asidoz, 7.35'in altında pH seviyesi olarak tanımlandı.Bulgular: Toplam kırk altı hasta ortalama yaş 64,06 ± 6,4 yıl dahil edildi. Yirmi üç hastada kan gazı değişikliği tespit edildi. Çalışma grubunda on sekiz hastada kombine asidoz saptandı. On iki hastada pH seviyesine göre asidoz, yedi hastada PaCO2 ≥ 45 mmHg, yedi hastada Laktat ≥1,6 mmol/L saptandı. Ortalama hastanede kalış süresi beş gündü 0-10 gün . NLR düzeyleri asidoz grupları arasında anlamlı düzeyde farklı bulunmadı ve hasta yaşı p = 0,907 ve hastanede yatış süresi ile ilişkili değildi p = 0,654 .Sonuç: NLR, RARP prosedürü uygulanan hastalarda asidoz veya uzun süreli hastanede kalış tahmininde belirteç değildir

Anahtar Kelimeler

• Nötrofil Lenfosit oranı, Robotik yardımlı asiste radikal prostatektomi, Asidoz

Retrospective Analysis of the Effects of Neutrophil / Lymphocyte Ratio on Intraoperative Acidosis Development and Hospitalization Time in Patients Underwent Radical Robotic Prostatectomy

Abstract

Objective: This study aimed the predictive value of the neutrophil to lymphocyte ratio NLR for intraoperative acidosis and postoperative lenght of hospital stay in patients undergoing robotic assisted radical prostatectomy procedure.Material and Methods: Patients with locally advanced prostate cancer undergoing elective robotic assisted radical prostatectomy procedure were included in the study. Inclusion criteria was being ASA I-II, and receiving sugammadex for recovery of neuromuscular block. Complete blood counts and blood-gas analyses were performed perioperatively. The neutrophil to lymphocyte ratio was calculated by dividing neutrophil counts to lymphocyte counts. Acidosis was defines as pH levels below 7.35.Results: A total of forty-six patients mean age 64.06±6.4 years were included. Blood gas changes were detected in twenty three patients. Eighteen patients in the study population had combined acidosis. Twelve patients had acidosis according to pH levels, seven patients had PaCO2 ≥ 45 mmHg, and seven patients had Lactate ≥1.6 mmol/L. Median hospital stay was five days 0-10 days . NLR levels were not found to be significantly different between the groups, and were not correlated with patient age p=0.907 or duration of hospital stay p=0.654 .Conclusion: NLR was not found to be a marker for acidosis or predictive of prolonged hospital stay in patients undergoing the RARP procedure

Keywords

• Neutrophil lymphocyte ratio, Robotic assisted radical prostatectomy, Acidosis

References

1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):359-86.
2. Laviana AA, Hu JC. A comparison of the robotic-assisted versus retropubic radical prostatectomy. Minerva Urol Nefrol 2013;65(3):161-70.
3. Oksar M, Akbulut Z, Ocal H, Balbay MD, Kanbak O. Robotic prostatectomy: The anesthetist’s view for robotic urological surgeries, a prospective study. Rev Bras Anestesiol 2014;64(5):307-13.
4. Goodale RL, Beebe DS, McNevin MP, Boyle M, Letourneau JG, Abrams JH, Cerra FB. Hemodynamic, respiratory, and metabolic effects of laparoscopic cholecystectomy. Am J Surg 1993;166(5):533-7.
5. Blobner M, Frick CG, Stäuble RB, Feussner H, Schaller SJ, Unterbuchner C, Lingg C, Geisler M, Fink H. Neuromuscular blockade improves surgical conditions (NISCO). Surg Endosc 2015;29(3):627-36.
6. Martini CH, Boon M, Bevers RF, Aarts LP, Dahan A. Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. Br J Anaesth 2014;112(3):498-505.
7. Torensma B, Martini CH, Boon M, Olofsen E, In ‘t Veld B, Liem RS, Knook MT, Swank DJ, Dahan A. Deep neuromuscular block improves surgical conditions during bariatric surgery and reduces postoperative pain: A randomized double blind controlled trial. PLoS One 2016;11(12): e0167907.
8. Santos HO, Izidoro LFM. Neutrophil-Lymphocyte ratio in cardiovascular disease risk assessment. Int J Cardiovasc Sci 2018 ahead of print Epub.

9. Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, Leibowitz-Amit R, Sonpavde G, Knox JJ, Tran B, Tannock IF, Amir E. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6): dju124.
10. Tang L, Li X, Wang B, Luo G, Gu L, Chen L, Liu K, Gao Y, Zhang X. Prognostic value of neutrophil-to- lymphocyte ratio in localized and advanced prostate cancer: A systematic review and meta-analysis. PLoS One 2016;11(4): e0153981.
11. Kim WH, Jin HS, Ko JS, Hahm TS, Lee SM, Cho HS, Kim MH. The effect of anesthetic techniques on neutrophil-to-lymphocyte ratio after laparoscopy- assisted vaginal hysterectomy. Acta Anaesthesiol Taiwan 2011;49(3): 83-7.
12. Ogawa K, Hirai M, Katsube T, Murayama M, Hamaguchi K, Shimakawa T, Naritake Y, Hosokawa T, Kajiwara T. Suppression of cellular immunity by surgical stress. Surgery 2000;127(3):329-36.
13. Kuralay F, Çavdar Z. İnflamatuar medyatörlere toplu bir bakış. Genel Tıp Derg 2006;16(3): 143-52.
14. Crozier TA, Müller JE, Quittkat D, Sydow M, Wuttke W, Kettler D. Effect of anaesthesia on the cytokine responses to abdominal surgery. British Journal of Anaesthesia 1994;72(3):280-5.
15. Ateş E, Akın Y, İpekçi T, Pelit ES, Alkan İ, Çiftçi H, Yeni E. Impact of preoperative neutrophil to lymphocyte ratio in patients with benign prostate hyperplasia undergo open prostatectomy: A pilot study Akd Med J / Akd Tıp D 2018;2:165-9.