[S100B level and cognitive dysfunction after robotic-assisted laparoscopic radical prostatectomy procedures: a prospective observational study]

Abstract

Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP).

Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively.

Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both).

Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD.

Trial Registry Number: Clinicaltrials.gov (N° NCT03018522).

Keywords: Disfunção cognitiva pós‐operatória; Postoperative cognitive dysfunction; Prostatectomia radical laparoscópica assistida por robô; Robotic assisted laparoscopic radical prostatectomy; S100B; S100B protein.

Figure 1

A, Serum S100B level profiles according to presence or absence of POCD on postoperative (postop) day 7. Data are shown as mean ± standard deviation. (a) Significant difference at postop 30 min between patients with and without POCD (p = 0.0001). (b) Significant difference at postop 24 h between patients with and without POCD (p = 0.001). B, Serum S100B level profiles according to presence or absence of POCD at postoperative (postop) 3 months. Data are shown as mean ± standard deviation. (a) Significant difference at postop 30 min between patients with and without POCD (p = 0.0001). (b) Significant difference at postop 24 h between patients with and without POCD (p = 0.001).