Matthew K Tollefson1, R Jeffrey Karnes2, Laureano Rangel2, Rachel Carlson2, Stephen A Boorjian2. 1. Departments of Urology and Health Sciences Research (LR, RC), Mayo Medical School and Mayo Clinic, Rochester, Minnesota. Electronic address: tollefson.matthew@mayo.edu. 2. Departments of Urology and Health Sciences Research (LR, RC), Mayo Medical School and Mayo Clinic, Rochester, Minnesota.
Abstract
PURPOSE: Venous thromboembolic events are the most common nonoperative complication after radical prostatectomy and they represent the most common cause of death within 30 days of surgery. While effective mechanical and chemoprophylaxis exists, such prophylaxis may also be associated with increased complications. To identify venous thromboembolic event risk factors and, thereby, facilitate targeted prophylaxis we characterized clinicopathological variables associated with these events in patients undergoing radical prostatectomy. MATERIALS AND METHODS: We reviewed the records of 18,472 consecutive patients who underwent radical prostatectomy with pelvic lymphadenectomy for prostate cancer at our institution from 1987 to 2010. Patients were followed postoperatively for complications. Venous thromboembolic events within 30 days of surgery were recorded. Logistic regression models were used to analyze clinicopathological variables associated with venous thromboembolic events. RESULTS: We identified symptomatic venous thromboembolic events in 271 patients (1.4%). This diagnosis was not associated with preoperative body mass index, prostate specific antigen, Gleason score or cancer recurrence. However, the diagnosis was significantly associated with nonO blood type (OR 1.98, p = 0.004), an increasing number of lymph nodes removed (OR 1.05, p = 0.035) and blood transfusion (OR 1.30, p = 0.02). Patients with venous thromboembolic events were significantly more likely to die within 30 days of surgery (3.0% vs 0%, p <0.001). CONCLUSIONS: Blood type, pelvic lymphadenectomy extent and blood transfusion are significant risk factors for symptomatic venous thromboembolic event before radical prostatectomy plus pelvic lymph node dissection. These data should be used for patient counseling, particularly in regard to obviating lymphadenectomy in patients at low risk and for individualizing prophylaxis for venous thromboembolic event in patients at higher risk.
PURPOSE:Venous thromboembolic events are the most common nonoperative complication after radical prostatectomy and they represent the most common cause of death within 30 days of surgery. While effective mechanical and chemoprophylaxis exists, such prophylaxis may also be associated with increased complications. To identify venous thromboembolic event risk factors and, thereby, facilitate targeted prophylaxis we characterized clinicopathological variables associated with these events in patients undergoing radical prostatectomy. MATERIALS AND METHODS: We reviewed the records of 18,472 consecutive patients who underwent radical prostatectomy with pelvic lymphadenectomy for prostate cancer at our institution from 1987 to 2010. Patients were followed postoperatively for complications. Venous thromboembolic events within 30 days of surgery were recorded. Logistic regression models were used to analyze clinicopathological variables associated with venous thromboembolic events. RESULTS: We identified symptomatic venous thromboembolic events in 271 patients (1.4%). This diagnosis was not associated with preoperative body mass index, prostate specific antigen, Gleason score or cancer recurrence. However, the diagnosis was significantly associated with nonO blood type (OR 1.98, p = 0.004), an increasing number of lymph nodes removed (OR 1.05, p = 0.035) and blood transfusion (OR 1.30, p = 0.02). Patients with venous thromboembolic events were significantly more likely to die within 30 days of surgery (3.0% vs 0%, p <0.001). CONCLUSIONS: Blood type, pelvic lymphadenectomy extent and blood transfusion are significant risk factors for symptomatic venous thromboembolic event before radical prostatectomy plus pelvic lymph node dissection. These data should be used for patient counseling, particularly in regard to obviating lymphadenectomy in patients at low risk and for individualizing prophylaxis for venous thromboembolic event in patients at higher risk.
Authors: Moritz Stolla; Majed A Refaai; Joanna M Heal; Sherry L Spinelli; Olivier Garraud; Richard P Phipps; Neil Blumberg Journal: Front Immunol Date: 2015-02-02 Impact factor: 7.561