Comparison of plasma neutrophil gelatinase-associated lipocalin (NGAL) levels after robot-assisted laparoscopic and retropubic radical prostatectomy: an observational study
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.
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.
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-h was more sensitive in the early diagnosis of AKI in RALP.
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.