Objectives: To evaluate in a prospective, controlled, nonrandomized study the surgical stress and acute-phase systemic response in robotic-assisted laparoscopic prostatectomy (RALP) compared to open radical retro-pubic prostatectomy (ORRP) by measuring humoral mediators. Methods: Forty consecutive patients undergoing either RALP or ORRP were prospectively included to assess the extent of systemic response. Blood samples were collected before surgery (T1), at the time of prostatectomy (T2), at the time of wound closure (T3), and 12 h (T4), 24 h (T5), and 48 h (T6) after surgery, and assayed for interleukins (IL-6 and IL-10), C-reactive protein (CRP), and hemoglobin. A 2-sided p < 0.05 was considered to indicate significance. Results: Baseline levels of IL-6, IL-10, and CRP were comparable in both arms of the study. IL-6 and IL-10 increased in both groups during surgery and reached maximum levels at 12 and 24 h after surgery. The RALP and RRP groups differed significantly at T2 (p = 0.009), T3 (p = 0.046), T5 (p = 0.05) and T6 (p = 0.0007) for IL-6, and at T3 (p = 0.05) and T4 (p = 0.05) for IL-10. CRP levels differed significantly at 48 h postoperative (p = 0.0053). The maximum levels of all 3 mediators in the RALP group were significantly lower than those in the open surgery group. Patients in the RALP group experienced less pain from day 2 to 4 according to the Visual Analog Scale (p < 0.05). Conclusions: The study suggests that IL-6 and IL-10 are useful objective markers for surgical stress and that tissue trauma and activation of post-aggression metabolism seem to be less in RALP compared to ORRP.

Journal Section:
Editor's choice
Keywords:
Invasiveness, Stress response, Interleukin, Robotic-assisted, Open prostatectomy
1.
Montorsi F, Wilson TG, Rosen RC, et al: Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 2012;62:368-381.
2.
American Urological Association: Prostate Cancer. Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update. American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/mainreports/proscan07/content.pdf.
3.
Ficarra V, Novara G, Artibani W, et al: Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 2009;55:1037-1063.
4.
Novara G, Ficarra V, Rosen RC, et al: Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012;62:431-452.
5.
Jurczok A, Zacharias M, Wagner S, Hamza A, Fornara P: Prospective non-randomized evaluation of four mediators of the systemic response after extraperitoneal laparoscopic and open retropubic radical prostatectomy. BJU Int 2007;99:1461-1466.
6.
Miyake H, Kawabata G, Gotoh A, et al: Comparison of surgical stress between laparoscopy and open surgery in the field of urology by measurement of humoral mediators. Int J Urol 2002;9:329-333.
7.
Fracalanza S, Ficarra V, Cavalleri S, et al: Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study. BJU Int 2008;101:1145-1149.
8.
Schlag G, Redl H: Mediators of injury and inflammation. World J Surg 1996;20:406-410.
9.
Gabay C, Kushner I: Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340:448-454.
10.
Kragsbjerg P, Holmberg H, Vikerfors T: Serum concentrations of interleukin-6, tumour necrosis factor-alpha, and C-reactive protein in patients undergoing major operations. Eur J Surg 1995;161:17-22.
11.
Karayiannakis AJ, Makri GG, Mantzioka A, Karousos D, Karatzas G: Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial. Br J Surg 1997;84:467-471.
12.
Jess P, Schultz K, Bendtzen K, Nielsen OH: Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomized prospective study. Eur J Surg 2000;166:540-544.
13.
Moran PS, O'Neill M, Teljeur C, et al: Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: a systematic review and meta-analysis. Int J Urol 2013;20:312-321.
14.
Vittimberga FJ, Foley DP, Meyers WC, Callery MP: Laparoscopic surgery and the systemic immune response. Ann Surg 1998;227:326-334.
15.
Weissman C: The metabolic response to stress: an overview and update. Anesthesiology 1990;73:308-327.
16.
Fornara P, Doehn C, Seyfarth M, Jocham D: Why is urological laparoscopy minimally invasive? Eur Urol 2000;37:241-250.
17.
Baigrie RJ, Lamont PM, Kwiatkowski D, Dallman MJ, Morris PJ: Systemic cytokine response after major surgery. Br J Surg 1992;79:757-760.
18.
Shenkin A, Fraser WD, Series J, et al: The serum interleukin-6 response to elective surgery. Lymphokine Res 1989;8:123-127.
19.
Cruickshank AM, Fraser WD, Burns HJ, Van Damme J, Shenkin A: Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci (Lond) 1990;79:161-165.
20.
Baigrie RJ, Lamont PM, Kwiatkowski D, Dallman MJ, Morris PJ: Systemic cytokine response after major surgery. Br J Surg 1992;79:757-760.
21.
Kristiansson M, Saraste L, Soop M, Sundqvist KG, Thorne A: Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy. Acta Anaesthesiol Scand 1999;43:146-152.
22.
Bellon JM, Manzano L, Larrad A, Honduvilla GN, Bujan J, Alvarez-Mon M: Endocrine and immune response to injury after open and laparoscopic cholecystectomy. Int Surg 1998;83:24-27.
23.
Maruszynski M, Pojda Z: Interleukin 6 (IL-6) levels in the monitoring of surgical trauma. A comparison of serum IL-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy. Surg Endosc 1995;9:882-885.
24.
Akhtar K, Kamalky-asl ID, Lamb WR, et al: Metabolic and inflammatory responses after laparoscopic and open inguinal hernia repair. Ann R Coll Surg Engl 1998;80:125-130.
25.
Ellstrom M, Bengtsson A, Tylman M, Haeger M, Olsson JH, Hahlin M: Evaluation of tissue trauma after laparoscopic and abdominal hysterectomy: measurements of neutrophil activation and release of interleukin-6, cortisol, and C-reactive protein. J Am Coll Surg 1996;182:423-430.
26.
Greco F, Hoda MR, Wagner S, et al: Adipocytokine: a new family of inflammatory and immunologic markers of invasiveness in major urologic surgery. Eur Urol 2010;58:781-787.
27.
Ogata M, Okamoto K, Kohriyama K, Kawasaki T, Itoh H, Shigematsu A: Role of interleukin-10 on hyporesponsiveness of endotoxin during surgery. Crit Care Med 2000;28:3166-3170.
28.
Kato M, Honda I, Suzuki H, Murakami M, Matsukawa S, Hashimoto Y: Interleukin-10 production during and after upper abdominal surgery. J Clin Anesth 1998;10:184-188.
29.
Brune IB, Wilke W, Hensler T, et al: Downregulation of T helper type 1 immune response and altered proinflammatory and anti-inflammatory T cell cytokine balance following conventional but not laparoscopic surgery. Am J Surg 1999;177:55-60.
30.
Webster TM, Herrell SD, Chang SS, et al: Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain. J Urol 2005;174:912-914; discussion 914.
31.
Tewari A, Srivasatava A, Menon M, et al: A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 2003;92:205-210.
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