858 ROBOT-ASSISTED RADICAL PROSTATECTOMY IN PATIENTS MAINTAINED ON PREOPERATIVE DUAL ANTIPLATELET THERAPY: A PROPENSITY SCORE-MATCHING STUDY (2013)

You have accessJournal of UrologyTechnology & Instruments: Robotics: Benign & Malignant Disease (I)1 Apr 2013858 ROBOT-ASSISTED RADICAL PROSTATECTOMY IN PATIENTS MAINTAINED ON PREOPERATIVE DUAL ANTIPLATELET THERAPY: A PROPENSITY SCORE-MATCHING STUDY Joo Yong Lee, Jong Chan Kim, Jae Won Park, Richilda Red Diaz, Kwang Hyun Kim, Hye Young Lee, Jae Seung Chung, Kang Su Cho, Won Sik Ham, and Young Deuk Choi Joo Yong LeeJoo Yong Lee Seoul, Korea, Republic of More articles by this author , Jong Chan KimJong Chan Kim Seoul, Korea, Republic of More articles by this author , Jae Won ParkJae Won Park Seoul, Korea, Republic of More articles by this author , Richilda Red DiazRichilda Red Diaz Seoul, Korea, Republic of More articles by this author , Kwang Hyun KimKwang Hyun Kim Seoul, Korea, Republic of More articles by this author , Hye Young LeeHye Young Lee Seoul, Korea, Republic of More articles by this author , Jae Seung ChungJae Seung Chung Busan, Korea, Republic of More articles by this author , Kang Su ChoKang Su Cho Seoul, Korea, Republic of More articles by this author , Won Sik HamWon Sik Ham Seoul, Korea, Republic of More articles by this author , and Young Deuk ChoiYoung Deuk Choi Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.426AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To examine the operative and postoperative results of 21 patients maintained on antiplatelet agents who underwent robot-assisted radical prostatectomy (RARP), compared with a control group, using propensity scores. METHODS Operative results from 21 patients requiring long-term oral antiplatelet therapy including acetylsalicylic acid and clopidogrel due to the presence of known coronary artery disease, who underwent robot-assisted radical prostatectomy between January 2005 and June 2012 were analyzed. Propensity scores for an established control group were calculated for each patient using multivariable logistic regression based upon the following covariates: age, body mass index, preoperative prostate-specific antigen level, prostate volume, biopsy Gleason score, clinical tumor stage, and D'Amico risk stratification. Propensity score-matching was performed to select the most similar propensity scores across group without antiplatelet therapy, in a 1:1 ratio with respect to the reference group of patients who underwent RARP with antiplatelet therapy. RESULTS In 42 patients, the mean age was 69.3±5.3 years and mean follow-up was 32.8±20.8 months. There were no statistical differences in variables used in propensity score-matching. Operation time, estimated blood loss, catheterization, and surgical margin positivity were not significantly different between the two groups. Hospital stay duration in patients with continuous antiplatelet agent therapy was significantly longer than the control group (7.3±3.7 versus 3.7±1.7 days, P<0.001). In a log-rank test using the Kaplan-Meier curve, there were no statistical differences in biochemical disease recurrence between the two groups. CONCLUSIONS RARP may be performed safely in patients unable to discontinue antiplatelet agents if particular attention is paid to hemostasis. Comparison of operative and postoperative outcomes between the two groups Total Group 1 Group 2 P-value No. patients 42 21 21 Age, years 69.3±5.3 68.5±5.4 64.6±7.5 0.480a BMI, kg/m2 23.5±2.3 23.4±2.3 23.6±3.3 0.930a PSA ng/mL 13.0 14.5 54.4 0.285a Prostate volume 31.0±10.9 30.31±12.49 25.75±8.06 0.908a Preoperative GS 6.5±0.9 6.7±0.9 7.9±0.9 0.248a Clinical stage (%) 0.251b cT1 15 (36) 5 (24) 10 (48) 0.197c cT2 21 (50) 12 (57) 9 (43) 0.537b cT3 6 (14) 4 (19) 2 (10) 0.663c D'Amico risk (%) 0.199b Low 15 (36) 7 (33) 8 (38) 1.000b Intermediate 3 (7) 3 (14) 0 (0) 0.232c High 24 (57) 11 (52) 13 (17) 0.755b Group 1: patients with antiplatelet therapy during robot-assisted radical prostatectomy Group 2: patients without antiplatelet therapy who were matched using propensity scores OR: operating room time, EBL: estimated blood loss, LOS: length of stay, SMR: surgical margin rate, GS: Gleason score a Mann-Whitney u-test, b chi-square test, c Fisher's exact test Comparison of operative and postoperative outcomes between the two groups Total Group 1 Group 2 P-value No. of patients 42 21 21 OR time, min 126.4±18.8 128.1±21.4 124.8±16.3 0.659a EBL, mL 285.4±150.3 257.1±119.7 314.3±174.0 0.451a Catheterization duration, days 8.1±1.7 8.5±2.2 7.6±1.1 0.350a LOS, days 5.5±3.4 7.3±3.7 3.7±1.7 <0.001a SMR (%) 12 (29) 7 (33) 5 (24) 0.733b Postoperative GS 7.0±1.1 7.0±1.2 7.0±1.1 0.884a Pathologic stage (%) 0.757b pT2 20 (48) 9 (43) 11 (52) pT3 22 (52) 12 (57) 10 (48) Biochemical recurrence (%) 8 (19) 6 (29) 2 (10) 0.238c Group 1: patients with antiplatelet therapy during robot-assisted radical prostatectomy Group 2: patients without antiplatelet therapy who were matched using propensity scores OR: operating room time, EBL: estimated blood loss, LOS: length of stay, SMR: surgical margin rate, GS: Gleason score a Mann-Whitney u-test, b chi-square test, c Fisher's exact test © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e353-e354 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joo Yong Lee Seoul, Korea, Republic of More articles by this author Jong Chan Kim Seoul, Korea, Republic of More articles by this author Jae Won Park Seoul, Korea, Republic of More articles by this author Richilda Red Diaz Seoul, Korea, Republic of More articles by this author Kwang Hyun Kim Seoul, Korea, Republic of More articles by this author Hye Young Lee Seoul, Korea, Republic of More articles by this author Jae Seung Chung Busan, Korea, Republic of More articles by this author Kang Su Cho Seoul, Korea, Republic of More articles by this author Won Sik Ham Seoul, Korea, Republic of More articles by this author Young Deuk Choi Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...