Stavros I Tyritzis1, Anna Wallerstedt2, Gunnar Steineck3, Tommy Nyberg4, Jonas Hugosson5, Anders Bjartell6, Ulrica Wilderäng7, Thordis Thorsteinsdottir8, Stefan Carlsson2, Johan Stranne5, Eva Haglind9, Nils Peter Wiklund2. 1. Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece. Electronic address: stavros.tyritzis.2@ki.se. 2. Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 3. Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 4. Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden. 5. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 6. Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Oncology, Lund University, Lund, Sweden. 7. Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 8. Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Faculty of Nursing, University of Iceland, Reykjavik, Iceland. 9. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Abstract
PURPOSE: Lymph node dissection in patients with prostate cancer may increase complications. An association of lymph node dissection with thromboembolic events was suggested. We compared the incidence and investigated predictors of deep venous thrombosis and pulmonary embolism among other complications in patients who did or did not undergo lymph node dissection during open and robot-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS: Included in study were 3,544 patients between 2008 and 2011. The cohort was derived from LAPPRO, a multicenter, prospective, controlled trial. Data on adverse events were extracted from patient completed questionnaires. Our primary study outcome was the prevalence of deep venous thrombosis and/or pulmonary embolism. Secondary outcomes were other types of 90-day adverse events and causes of hospital readmission. RESULTS: Lymph node dissection was performed in 547 patients (15.4%). It was associated with eightfold and sixfold greater risk of deep venous thrombosis and pulmonary embolism events compared to that in patients without lymph node dissection (RR 7.80, 95% CI 3.51-17.32 and 6.29, 95% CI 2.11-18.73, respectively). Factors predictive of thromboembolic events included a history of thrombosis, pT4 stage and Gleason score 8 or greater. Open radical prostatectomy and lymph node dissection carried a higher risk of deep venous thrombosis and/or pulmonary embolism than robot-assisted laparoscopic radical prostatectomy (RR 12.67, 95% CI 5.05-31.77 vs 7.52, 95% CI 2.84-19.88). In patients without lymph node dissection open radical prostatectomy increased the thromboembolic risk 3.8-fold (95% CI 1.42-9.99) compared to robot-assisted laparoscopic radical prostatectomy. Lymph node dissection induced more wound, respiratory, cardiovascular and neuromusculoskeletal events. It also caused more readmissions than no lymph node dissection (14.6% vs 6.3%). CONCLUSIONS: Among other adverse events we found that lymph node dissection during radical prostatectomy increased the incidence of deep venous thrombosis and pulmonary embolism. Open surgery increased the risks more than robot-assisted surgery. This was most prominent in patients who were not treated with lymph node dissection.
PURPOSE: Lymph node dissection in patients with prostate cancer may increase complications. An association of lymph node dissection with thromboembolic events was suggested. We compared the incidence and investigated predictors of deep venous thrombosis and pulmonary embolism among other complications in patients who did or did not undergo lymph node dissection during open and robot-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS: Included in study were 3,544 patients between 2008 and 2011. The cohort was derived from LAPPRO, a multicenter, prospective, controlled trial. Data on adverse events were extracted from patient completed questionnaires. Our primary study outcome was the prevalence of deep venous thrombosis and/or pulmonary embolism. Secondary outcomes were other types of 90-day adverse events and causes of hospital readmission. RESULTS: Lymph node dissection was performed in 547 patients (15.4%). It was associated with eightfold and sixfold greater risk of deep venous thrombosis and pulmonary embolism events compared to that in patients without lymph node dissection (RR 7.80, 95% CI 3.51-17.32 and 6.29, 95% CI 2.11-18.73, respectively). Factors predictive of thromboembolic events included a history of thrombosis, pT4 stage and Gleason score 8 or greater. Open radical prostatectomy and lymph node dissection carried a higher risk of deep venous thrombosis and/or pulmonary embolism than robot-assisted laparoscopic radical prostatectomy (RR 12.67, 95% CI 5.05-31.77 vs 7.52, 95% CI 2.84-19.88). In patients without lymph node dissection open radical prostatectomy increased the thromboembolic risk 3.8-fold (95% CI 1.42-9.99) compared to robot-assisted laparoscopic radical prostatectomy. Lymph node dissection induced more wound, respiratory, cardiovascular and neuromusculoskeletal events. It also caused more readmissions than no lymph node dissection (14.6% vs 6.3%). CONCLUSIONS: Among other adverse events we found that lymph node dissection during radical prostatectomy increased the incidence of deep venous thrombosis and pulmonary embolism. Open surgery increased the risks more than robot-assisted surgery. This was most prominent in patients who were not treated with lymph node dissection.
Authors: Wojciech Michalski; Grazyna Poniatowska; Joanna Jonska-Gmyrek; Jakub Kucharz; Pawel Stelmasiak; Karol Nietupski; Katarzyna Ossolinska-Skurczynska; Michal Sobieszczuk; Tomasz Demkow; Pawel Wiechno Journal: Med Oncol Date: 2019-11-25 Impact factor: 3.064
Authors: Peter Chang; Andrew A Wagner; Meredith M Regan; Joseph A Smith; Christopher S Saigal; Mark S Litwin; Jim C Hu; Matthew R Cooperberg; Peter R Carroll; Eric A Klein; Adam S Kibel; Gerald L Andriole; Misop Han; Alan W Partin; David P Wood; Catrina M Crociani; Thomas K Greenfield; Dattatraya Patil; Larry A Hembroff; Kyle Davis; Linda Stork; Daniel E Spratt; John T Wei; Martin G Sanda Journal: J Urol Date: 2021-08-26 Impact factor: 7.450
Authors: Rafael Rocha Tourinho-Barbosa; Marcos Tobias-Machado; Adalberto Castro-Alfaro; Gabriel Ogaya-Pinies; Xavier Cathelineau; Rafael Sanchez-Salas Journal: Arab J Urol Date: 2017-12-14