Kronik oral antikoagülan kullanımının robotik radikal prostatektomi sonuçlarına etkisi

Abstract

Amaç: Kardiyovasküler hastalıklar nedeniyle kronik oral antikoagulan KOA kullanımının robotik radikal prostatektomi sonuçlarına etkisini araştırmak.Materials and Methods: Kliniğimizde 2008-2012 yılları arasında prostat kanseri tanısıyla robotik radikal prostatektomi uygulanan 200 hasta çalışmaya alındı. Birinci grupta kronik oral antikoagulan kullanan hastalara operasyondan bir hafta önce oral antikoagulan tedavi kesilerek düşük molekül ağırlıklı heparin DMAH başlandı ve ameliyat sonrası bir hafta devam edildi. İkinci grup, KOA kullanım öyküsü bulunmayan hastalar olup, ameliyat öncesi bir gün ve mobilizasyona kadar geçen süre boyunca düşük molekül ağırlıklı heparin subkutan profilaktik olarak verildi. Her iki grup operasyon süresi, ortalama kan kaybı, transfüzyon ihtiyacı, dren çekilme süresi, komplikasyon oranları ve hastanede kalış süreleri açısından karşılaştırıldı.Bulgular: Çalışmaya dahil edilen hastaların 24’ü oral antikoagulan kullanıyor idi. Kronik oral antikoagulan kullanan hastaların ortalama operasyon süresi 212,4 dakika iken kullanmayan grupta 212,7 dakika olarak saptandı p=0,86 . Tahmini kan kaybı grup 1 için 205 ml, grup 2 için 223 ml idi p=0,66 . Dren çekilmesi sırasıyla grup 1 ve grup 2 için 2,6 gün ve 2,2 gündü p=0,08 . Hastanede kalış süresi grup 1 için 3,8 gün grup 2 için 3,2 gün olarak hesaplandı p=0,09 . Her iki grubun total komplikasyon oranları %16 olarak gerçekleşti. Bununla birlikte minör ve majör komplikasyon oranları arasında da istatistiksel fark izlenmedi.Sonuç: Robotik radikal prostatektomi kronik oral antikoagulan kullanan cerrahi açıdan riskli hastalarda güvenle uygulanabilir

Keywords

• Prostatektomi,robotik,antikoagulan

The impact of chronic oral anticoagulant therapy on robotic radical prostatectomy outcomes

Abstract

Introduction: Patients undergoing robotic radical prostatectomy RARP who require chronic anticoagulant therapy due to cardiovascular conditions were evaluated for surgical outcomes. Materıal and Methods: In this study, 200 patients who underwent robotic radical prostatectomy with a diagnosis of prostate cancer between 2008 and 2012, were analyzed. In the first group, low molecular weight heparin LMWH was begun to be given to the patients by interrupting their use of oral anticoagulant therapy a week earlier than the surgery. The use of low molecular weight heparin was maintained about a week more after the surgery. The second group included patients who have no history of chronic use of oral anticoagulants therapy. To these patients, low molecular weight heparin as prophylactic was used subcutaneously a day before the surgery and continued until the mobilization. Operative time, blood loss, drain removal time, complication rates, length of hospital stay were compared between two groups.Results: In this study, 24 patients were using oral anticoagulant therapy. Mean operative time was 212,4 min in group 1 and 212,7 min in group 2 p=0.86 . Estimated blood loss was 205 ml and 223 ml in group 1 and 2, respectively p=0.66 . The drain was removed after 2.6 days in group 1 and 2.2 days in group 2. p=0.08 . The length of stay was a mean of 3.8 and 3.2 days in group 1 and 2 respectively p=0.09 . Total complication rate of both groups were 16%. In addition, no statistical difference was observed between minor and major complication rates. Conclusion: Robotic radical prostatectomy can be safely performed in patients who are at the risk of surgery and have been using chronic oral anticoagulant therapy

Keywords

• Prostatectomy,robotic,anticoagulant

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