Blood-sparing strategies in radical prostatectomy using temporary occlusion of the internal iliac arteries

BACKGROUND: Radical prostatectomy is the primary surgical treatment for localized prostate cancer. The procedure is often associated with substantial blood loss, particularly in patients with large prostate volumes. Reducing intraoperative blood loss during radical prostatectomy remains an important objective of contemporary oncological urology. One of the proposed approaches for preventing intraoperative hemorrhage is temporary interruption of blood flow through the internal iliac arteries; however, the scientific data on the application of this technique remain limited.

AIM: This work aimed to evaluate the effectiveness of short-term occlusion of the internal iliac arteries for reducing blood loss during radical prostatectomy in patients with large prostate volume.

METHODS: This single-center controlled study included 60 patients with localized prostate cancer and a prostate volume of ≥100 cm³. Patients were divided into a main group and a control group, with 30 patients in each. Patients in the main group underwent robotic radical prostatectomy with pelvic lymphadenectomy and temporary interruption of blood flow in the internal iliac arteries. Patients in the control group underwent standard radical prostatectomy with pelvic lymphadenectomy. The groups were comparable regarding the main clinical characteristics.

RESULTS: In the main group, blood loss did not exceed 350 mL and was more than twofold lower on average than in the control group: 161.2 vs. 376.1 mL, respectively (p < 0.001). Operative time was also significantly shorter in the main group compared with the control group: 156.4 vs. 188.4 minutes, respectively (p = 0.01). Two patients in the control group required intraoperative blood transfusion due to high blood loss, whereas no transfusions were required in the main group.

CONCLUSION: Radical prostatectomy with pelvic lymphadenectomy in patients with prostate cancer and large prostate volume (>100 cm³), when performed using temporary occlusion of the internal iliac arteries, allows for a substantial reduction in intraoperative blood loss and operative time.