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
Abstract
Keywords
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.
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References
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Submitted date:
08/11/2019
Accepted date:
03/07/2021