Estimated Blood Loss as a Predictor of Postoperative Continence and Oncologic Outcomes in Robot-Assisted Radical Prostatectomy: A Retrospective Analysis of 525 Cases

Abstract

Background: This study aimed to evaluate the relationship of perioperative estimated blood loss (EBL) with peri- and postoperative parameters during the robot-assisted radical prostatectomy (RARP) procedure.

Methods: In this retrospective study, data from patients with localized prostate cancer (PCa) who underwent RARP between December 2012 and August 2024 (n = 530) were analyzed. Patients with EBL of 100 ml or less were defined as group 1 (n = 359), and those with EBL exceeding 100 ml were defined as group 2 (n = 166). Perioperative data and postoperative functional and pathologic outcomes were recorded and compared between the two groups.

Results: The patients in group 2 had longer lymph node dissection time, prostatectomy time, anastomosis time, total operation time, drain removal time, and hospital stay, as well a greater EBL, higher surgical margin ratio, greater positive surgical margin according to pathologic stage, and longer time to reach continence (p = 0.001). No difference was observed between urinary incontinence (UI) scores at the sixth month postoperatively (p = 0.191). A high degree of correlation was observed between EBL and other parameters (drain removal time, hospital length of stay, time to reach continence, prostatectomy time, International Consultation on Incontinence Questionnaire [ICIQ] total score at the first and third months, and total operation and anastomosis time, respectively; rho-factor ≥ 0.5; p < 0.05). In the multivariate regression analysis, EBL was determined to be a predictive factor for achieving postoperative urinary continence.

Conclusions: The study demonstrated that perioperative EBL is associated with postoperative urinary continence and oncologic outcomes after RARP.

Aybal HC, Yilmaz M, Barlas IS, Duvarci M, Dagli I, Akdagcik Z, Guven S, Tunc L. Estimated Blood Loss as a Predictor of Postoperative Continence and Oncologic Outcomes in Robot-Assisted Radical Prostatectomy: A Retrospective Analysis of 525 Cases. Ann Surg Oncol. 2025 Aug 25. doi: 10.1245/s10434-025-18175-y. Epub ahead of print. PMID: 40853626.