Association Between Surgical Stress and Biochemical Recurrence After Robotic Radical Prostatectomy

Abstract

Background and Objectives: This study was conducted to identify whether surgical stress during the peri-operative period of robot-assisted radical prostatectomy might affect biochemical recurrence in patients with positive surgical margins.Methods: Participants in the present study were 324 consecutive patients with localized prostate cancer who underwent robot-assisted radical prostatectomy between February 2013 and June 2018. Positive surgical margins were diagnosed in 61 of them. Patients with positive surgical margins were divided into those with (n = 19) and those without (n = 42) biochemical recurrence. Lymph node dissection, estimated blood loss, inhalation anesthetic volume, and surgical duration were evaluated as indicators of surgical stress. White blood cell count, C-reactive protein, body temperature, and usage of analgesics were postoperatively evaluated as surrogate markers of surgical stress. The associations between factors, including patients' characteristics and pathological features, and biochemical recurrence were investigated.Results: In univariate analyses, surgical duration (P = 0.004), D'Amico risk class (P = 0.002), Gleason score (P = 0.022) and the number of positive cores in prostate biopsy (P = 0.009) were statistically significantly associated with biochemical recurrence. In multivariate analyses, only surgical duration was significantly associated with biochemical recurrence (P = 0.042), at a cut-off value of surgical duration of 228.5 minutes.Conclusions: Prolonged surgical duration is associated with biochemical recurrence in patients with positive surgical margins. Thus, surgical duration should be limited as much as possible to reduce surgical stress, which might cause biochemical recurrence.

Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer: the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies

“…One conclusion that can be drawn from the study by Choo et al 82 is that similar PSM rates do not imply similar BCR rates. In addition, Meguro et al 83 reported that in multivariate analyses, operative time was significantly associated with BCR, with a cut-off value of 228.5 min for operative time. They suggested that prolonged operative time was associated with BCR in patients with positive surgical margins.…”

Perioperative oncolytic virotherapy to counteract surgery-induced immunosuppression and improve outcomes in pancreatic ductal adenocarcinoma

“…It has been described that surgery creates a state of physical trauma and physiological stress that triggers cellular immune dysfunction ( 13 , 14 ). Our group and others have shown that the postoperative period represents a unique time frame of immunosuppression that can be hijacked by a tumor for its survival advantage in different cancer types ( 15 – 18 ). However, the idea of surgery-induced immunosuppression as a facilitator of recurrence and metastatic spread has not been explored in the context of pancreatic cancer.…”