Comparison of Cognitive Function After Robot-Assisted Prostatectomy and Open Retropubic Radical Prostatectomy: A Prospective Observational Single-Center Study

Beck, Stefanie; Zins, Linnea; Holthusen, C.; Rademacher, Cornelius; Breunig, Franziska von; Tennstedt, Pierre; Haese, Alexander; Graefen, Markus; Zöllner, Christian; Fischer, Marlene

doi:10.1016/j.urology.2019.12.045

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…The aim of this study was to compare HRQoL and cognitive failures between patients with and without DNCR following radical prostatectomy for prostate cancer. Patients who had been enrolled in a prospective cohort study to assess the incidence of DNCR during the early postoperative period were eligible for study participation [5]. The study was performed at the Martini-Klinik, a high-volume prostate cancer center in Northern Germany.…”

Section: Aim Study Design Setting and Participantsmentioning

confidence: 99%

“…The study was performed at the Martini-Klinik, a high-volume prostate cancer center in Northern Germany. Details of the initial study protocol have been reported previously [5]. In brief, patients scheduled for radical prostatectomy were enrolled between January 2015 and March 2016.…”

Section: Aim Study Design Setting and Participantsmentioning

confidence: 99%

“…Neuropsychological assessment and the definition of DNCR have been described in detail previously [5]. Briefly, the Mini-Mental Status Examination and the Patient Health Questionnaire-9 were used to screen for pre-existing cognitive impairment or signs of depression.…”

Section: Psychometric Assessmentmentioning

confidence: 99%

“…Of the 299 patients who were available for follow-up after 12 months, 64 had been diagnosed with DNCR in the early postoperative period [5]. Details of the neuropsychological test results are listed in Additional file 2.…”

Section: Study Populationmentioning

confidence: 99%

“…However, delayed neurocognitive recovery (DNCR)formerly postoperative cognitive dysfunction-is a common complication during the early postoperative period after radical prostatectomy [5]. Delayed neurocognitive recovery is defined as a postoperative decline in cognitive function affecting memory, information processing, and executive function [6].…”

Section: Introductionmentioning

confidence: 99%

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Health-related quality of life and self-reported cognitive function in patients with delayed neurocognitive recovery after radical prostatectomy: a prospective follow-up study

Kahl

Callsen

Beck

et al. 2021

Health Qual Life Outcomes

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Background Delayed neurocognitive recovery (DNCR) is a common and serious complication after radical prostatectomy. We hypothesized that patients with DNCR in the early postoperative period would report reduced health-related quality of life (HRQoL) and more cognitive failures 12 months after surgery, compared with patients without DNCR. Methods We performed a 12-month follow-up on 367 patients who had been enrolled in a prospective observational trial to study the incidence of DNCR after radical prostatectomy. Patients were screened for preoperative cognitive impairment and depression. We defined DNCR as a decline in cognitive function between days 3 and 5 after surgery, compared with baseline assessments. We evaluated HRQoL and cognitive failures 12 months after surgery with the 36-item Short Form Health Survey and the Cognitive Failures Questionnaire. General linear models were used to analyze associations of DNCR with HRQoL and cognitive failures. Results Delayed neurocognitive recovery in the early postoperative period was significantly associated with self-reported cognitive failures (B for no DNCR = − 0.411 [95% CI: − 0.798;0.024], p = 0.038), but not with physical (B = 0.082 [95% CI: − 0.021;0.186], p = 0.118) or mental HRQoL (B = − 0.044 [95% CI: − 0.149;0.062], p = 0.417) 12 months after surgery. Preoperative depression screening scores were significantly associated with self-reported cognitive failures and both physical and mental HRQoL 12 months after surgery. Conclusions Delayed neurocognitive recovery in the early period after radical prostatectomy has a long-term impact on patients’ daily lives by impairing memory, attention, action, and perception. Therefore, prevention of DNCR must be a priority for physicians and researchers. Consequent preoperative screening for depressive symptoms may facilitate early psycho-oncological intervention to improve postoperative HRQoL. Trials registrationDRKS00010014, date of registration: 21.03.2016, retrospectively registered.

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Section: Aim Study Design Setting and Participantsmentioning

confidence: 99%

Section: Aim Study Design Setting and Participantsmentioning

confidence: 99%

Section: Psychometric Assessmentmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Health-related quality of life and self-reported cognitive function in patients with delayed neurocognitive recovery after radical prostatectomy: a prospective follow-up study

Kahl

Callsen

Beck

et al. 2021

Health Qual Life Outcomes

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Intraoperative impaired cerebrovascular autoregulation and delayed neurocognitive recovery after major oncologic surgery: a secondary analysis of pooled data

Kahl

Rademacher

Harler

et al. 2021

J Clin Monit Comput

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Cerebral blood flow is tightly regulated by cerebrovascular autoregulation (CVA), and intraoperative impairment of CVA has been linked with perioperative neurocognitive disorders. We aim to assess whether impairment of CVA during major oncologic surgery is associated with delayed neurocognitive recovery (DNCR) postoperatively. We performed a secondary analysis of prospectively collected data. Patients were included if they had undergone complete pre- and postoperative neuropsychological assessments, continuous intraoperative measurement of CVA, and major oncologic surgery for visceral, urological, or gynecological cancer. Intraoperative CVA was measured using the time-correlation method based on near-infrared-spectroscopy, and DNCR was assessed with a neuropsychological test battery. A decline in cognitive function before hospital discharge compared with a preoperative baseline assessment was defined as DNCR. One hundred ninety-five patients were included in the analysis. The median age of the study population was 65 years (IQR: 60–68); 11 patients (5.6%) were female. Forty-one patients (21.0%) fulfilled the criteria for DNCR in the early postoperative period. We found a significant association between impaired intraoperative CVA and DNCR before hospital discharge (OR = 1.042 [95% CI: 1.005; 1.080], p = 0.028). The type of surgery (radical prostatectomy vs. other major oncologic surgery; OR = 0.269 [95% CI: 0.099; 0.728], p = 0.010) and premedication with midazolam (OR = 3.360 [95% CI: 1.039; 10.870], p = 0.043) were significantly associated with the occurrence of DNCR in the early postoperative period. Intraoperative impairment of CVA is associated with postoperative neurocognitive function early after oncologic surgery. Therefore, intraoperative monitoring of CVA may be a target for neuroprotective interventions. The initial studies were retrospectively registered with primary clinical trial registries recognized by the World Health Organization (ClinicalTrials.gov Identifiers: DRKS00010014, 21.03.2016 and NCT04101006, 24.07.2019).

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Mesial temporal atrophy in preoperative MRI rather than steep Trendelenburg position is associated with postoperative delirium in patients undergoing a major urologic surgery

Park,

Yoon

et al. 2023

Int Urol Nephrol

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Comparison of Cognitive Function After Robot-Assisted Prostatectomy and Open Retropubic Radical Prostatectomy: A Prospective Observational Single-Center Study

Cited by 8 publications

References 28 publications

Health-related quality of life and self-reported cognitive function in patients with delayed neurocognitive recovery after radical prostatectomy: a prospective follow-up study

Health-related quality of life and self-reported cognitive function in patients with delayed neurocognitive recovery after radical prostatectomy: a prospective follow-up study

Intraoperative impaired cerebrovascular autoregulation and delayed neurocognitive recovery after major oncologic surgery: a secondary analysis of pooled data

Mesial temporal atrophy in preoperative MRI rather than steep Trendelenburg position is associated with postoperative delirium in patients undergoing a major urologic surgery

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