Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.003
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of plasma neutrophil gelatinase-associated lipocalin (NGAL) levels after robot-assisted laparoscopic and retropubic radical prostatectomy: an observational study

Comparação dos níveis de lipocalina associada à gelatinase de neutrófilos plasmáticos (NGAL) após prostatectomia radical retropúbica e laparoscópica assistida por robô: um estudo observacional

Arzu Karaveli; Ali Sait Kavakli; Ozlem Cakin; Guzin Aykal; Ali Yildiz; Mutlu Ates

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Abstract

Abstract: Background and objectives: Patients undergoing radical prostatectomy are at increased risk of Acute Kidney Injury (AKI) because of intraoperative bleeding, obstructive uropathy, and older age. Neutrophil Gelatinase-Associated Lipocalin (NGAL) may become important for diagnosis of postoperative AKI after urogenital oncosurgery. The objective of this study was to evaluate and compare the efficacy of NGAL as a predictor of AKI diagnosis in patients who underwent Retropubic Radical Prostatectomy (RRP) and Robot-Assisted Laparoscopic Prostatectomy (RALP) for prostate cancer.

Methods: We included 66 patients who underwent RRP (n = 32) or RALP (n = 34) in this prospective, comparative, nonrandomized study. Patients’ demographic data, duration of surgery and anesthesia, amount of blood products, vasopressor therapy, intraoperative blood loss, fluid administration, length of hospital stay, creatinine, and plasma NGAL levels were recorded.

Results: Intraoperative blood loss, crystalloid fluid administration, and length of hospital stay were significantly shorter in RALP. There was no statistically significant difference between the groups in terms of intraoperative blood transfusion. Postoperative creatinine and plasma NGAL levels were increased in both groups. The 6-h NGAL levels were higher in RRP (p = 0.026). The incidence of AKI was 28.12% in RRP and 26.05% in RALP, respectively. The NGAL level at 6 hours was more sensitive in the early diagnosis of AKI in RALP.

Conclusion: Although postoperative serum NGAL levels were increased in both RRP and RALP, the 6-h NGAL levels were higher in RRP. RALP was associated with fewer intraoperative blood loss and fluid administration, and shorter length of hospital stay.

Keywords

Neutrophil gelatinase-associated lipocalin (NGAL), Prostatectomy, Acute kidney injury

Resumo

Justificativa e objetivos: Pacientes submetidos à prostatectomia radical apresentam risco aumentado de lesão renal aguda (LRA) devido ao sangramento intraoperatório, uropatia obstrutiva e idade avançada. A lipocalina associada à gelatinase de neutrófilos (NGAL) pode se tornar importante para o diagnóstico de LRA pós-operatória após oncocirurgia urogenital. O objetivo deste estudo foi avaliar e comparar a eficácia da NGAL como preditor de diagnóstico de LRA em pacientes submetidos à prostatectomia radical retropúbica (PRR) e prostatectomia laparoscópica assistida por robô (PLAR) para câncer de próstata.

Métodos: Foram incluídos 66 pacientes submetidos a PRR (n = 32) ou PLAR (n = 34) neste estudo prospectivo, comparativo e não randomizado. Os dados demográficos dos pacientes, duração da cirurgia e anestesia, quantidade de hemoderivados, terapia vasopressora, perda de sangue intraoperatória, administração de fluidos, tempo de internação hospitalar, creatinina e níveis plasmáticos de NGAL foram registrados.

Resultados: A perda sanguínea intraoperatória, a administração de cristaloides e o tempo de internação foram significativamente menores na PLAR. Não houve diferença estatisticamente significativa entre os grupos em relação à transfusão sanguínea intraoperatória. Os níveis pós-operatórios de creatinina e NGAL plasmático aumentaram em ambos os grupos. Os níveis de NGAL de 6 h foram maiores no PRR (p = 0,026). A incidência de LRA foi de 28,12% no PRR e 26,05% no PLAR, respectivamente. O nível de NGAL em 6 horas foi mais sensível no diagnóstico precoce de LRA em PLAR.

Conclusão: Embora os níveis séricos de NGAL no pós-operatório tenham aumentado tanto em PRR quanto em PLAR, os níveis de NGAL de 6 h foram maiores em PR. PLAR foi associado a menos perda de sangue intraoperatória e administração de fluidos, e menor tempo de internação hospitalar.
 

Palavras-chave

Lipocalina associada à gelatinase de neutrófilos (NGAL), Prostatectomia, Lesão renal aguda

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Submitted date:
08/11/2019

Accepted date:
03/07/2021

60749b22a95395748f0517a4 rba Articles

Braz J Anesthesiol

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