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

References

1 Joo EY, Moon YJ, Yoon SH, et al. Comparison of acute kidney injury after robot-assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a propensity score matching analysis. Medicine (Baltimore). 2016;95:e2650.

2 Rocco B, Matei DV, Melegari S, et al. Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU Int. 2009;104:991-5.

3 Haase-Fielitz A, Bellomo R, Devarajan P, et al. Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery - a prospective cohort study. Crit Care Med. 2009;37:553-60.

4 Awad H, Walker CM, Shaikh M, et al. Anesthetic considerations for robotic prostatectomy: a review of the literature. J Clin Anesth. 2012;24:494-504.

5 Chakraborty S, Kaur S, Guha S, et al. The multifaceted roles of neutrophil gelatinase associated lipocalin (NGAL) in inflammation and cancer. Biochim Biophys Acta. 2012;1826:129-69.

6 Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005;365:1231-8.

7 Niemann CU, Walia A, Waldman J, et al. Acute kidney injury during liver transplantation as determined by neutrophil gelatinase-associated lipocalin. Liver Transpl. 2009;15:1852-60.

8 Yeung ACY, Morozov A, Robertson FP, et al. Neutrophil Gelatinase-Associated Lipocalin (NGAL) in predicting acute kidney injury following orthotopic liver transplantation: a systematic review. Int J Surg. 2018;59:48-54.

9 Han WK, Wagener G, Zhu Y, et al. Urinary biomarkers in the early detection of acute kidney injury after cardiac surgery. Clin J Am Soc Nephrol. 2009;4:873-82.

10 Cruz DN, de Cal M, Garzotto F, et al. Plasma neutrophil gelatinase-associated lipocalin is an early biomarker for acute kidney injury in an adult ICU population. Intensive Care Med. 2010;36:444-51.

11 Orsolya M, Attila-Zoltan M, Gherman V, et al. The effect of anaesthetic management on neutrophil gelatinase associated lipocalin (NGAL) levels after robotic surgical oncology. J BUON. 2015;20:317-24.

12 Zappitelli M, Washburn KK, Arikan AA, et al. Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Crit Care. 2007;11:R84.

13 Wheeler DS, Devarajan P, Ma Q, et al. Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med. 2008;36:1297-303.

14 Chertow GM, Burdick E, Honour M, et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365-70.

15 Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, et al. Cost and Mortality Associated With Postoperative Acute Kidney Injury. Ann Surg. 2015;261:1207-14.

16 von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573-7.

17 Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1-138.

18 Rosendal C, Markin S, Hien MD, et al. Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy. J Clin Anesth. 2014;26:383-9.

19 Wilson T, Torrey R. Open versus robotic-assisted radical prostatectomy: which is better? Curr Opin Urol. 2011;21:200-5.

20 D’Alonzo RC, Gan TJ, Moul JW, et al. A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy. J Clin Anesth. 2009;21:322-8.

21 Saito J, Noguchi S, Matsumoto A, et al. Impact of robot-assisted laparoscopic prostatectomy on the management of general anesthesia: efficacy of blood withdrawal during a steep Trendelenburg position. J Anesth. 2015;29:487-91.

22 Danic MJ, Chow M, Alexander G, et al. Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases. J Robot Surg. 2007;1:119-23.

23 Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy. Minerva Anestesiol. 2012;78:596-604.

24 Yonekura H, Hirate H, Sobue K. Comparison of anesthetic management and outcomes of robot-assisted vs pure laparoscopic radical prostatectomy. J Clin Anesth. 2016;35:281-6.

25 Tooher R, Swindle P, Woo H, et al. Laparoscopic radical prostatectomy for localized prostate cancer: a systematic review of comparative studies. J Urol. 2006;175:2011-7.

26 Haas S, Haese A, Goetz AE, et al. Haemodynamics and cardiac function during robotic-assisted laparoscopic prostatectomy in steep Trendelenburg position. Int J Med Robot. 2011;7: 408-13.

27 Bishara B, Karram T, Khatib S, et al. Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine. Surg Endosc. 2009;23:568-76.

28 Sassa N, Hattori R, Yamamoto T, et al. Direct visualization of renal hemodynamics affected by carbon dioxide-induced pneumoperitoneum. Urology. 2009;73:311-5.

29 Costalonga EC, Costa ESVT, Caires R, et al. Prostatic surgery associated acute kidney injury. World J Nephrol. 2014;3:198-209.

30 Fanning N, Galvin S, Parke R, et al. A prospective study of the timing and accuracy of neutrophil gelatinase-associated lipocalin levels in predicting acute kidney injury in highrisk cardiac surgery patients. J Cardiothorac Vasc Anesth. 2016;30:76-81.

31 Abdel-Rahman EM, Okusa MD. Effects of aging on renal function and regenerative capacity. Nephron Clin Pract. 2014;127:15-20.

32 Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461-70.

33 da Rocha EP, Yokota LG, Sampaio BM, et al. Urinary Neutrophil Gelatinase-Associated Lipocalin Is Excellent Predictor of Acute Kidney Injury in Septic Elderly Patients. Aging Dis. 2018;9:182-91.

34 Haase M, Bellomo R, Devarajan P, et al. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and metaanalysis. Am J Kidney Dis. 2009;54:1012-24.

35 Mihaly OB, Rahaian R, Bodolea C, et al. Accuracy of neutrophil gelatinase-associated lipocalin in detecting acute kidney injury after urogenital robotic assisted laparoscopic surgery under general anesthesia. Appl Med Inform. 2012;30:47-56.
 


Submitted date:
08/11/2019

Accepted date:
03/07/2021

60749b22a95395748f0517a4 rba Articles

Braz J Anesthesiol

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