Felix Preisser1, Elio Mazzone2, Sebastiano Nazzani3, Marco Bandini2, Zhe Tian4, Michele Marchioni5, Thomas Steuber6, Fred Saad7, Francesco Montorsi8, Shahrokh F Shariat9, Hartwig Huland6, Markus Graefen6, Derya Tilki10, Pierre I Karakiewicz7. 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada; Institut du Cancer de Montréal, Montréal, Québec, Canada; Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: felixpreisser@gmx.de. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada; Institut du Cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada; Institut du Cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. 4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. 5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy. 6. Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 7. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada; Institut du Cancer de Montréal, Montréal, Québec, Canada. 8. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 9. Department of Urology, Medical University of Vienna, Vienna, Austria. 10. Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
Cytoreductive radical prostatectomy (CRP) may offer a survival advantage, according to several retrospective analyses. However, few data are available regarding the morbidity of radical prostatectomy in the metastatic setting. We addressed intra- and postoperative complications of CRP relative to radical prostatectomy for nonmetastatic prostate cancer (nmRP). Within the National Inpatient Sample database (2008-2013), we identified patients who underwent CRP versus nmRP. Propensity score matching to reduce the effect of inherent differences between CRP and nmRP patients, multivariable logistic regression models, Poisson regression models, and linear regression models were used. Of 76 378 patients, 1.2% (n=953) underwent CRP. CRP resulted in higher rates of overall (odds ratio [OR]: 1.34, p=0.01), intraoperative (OR: 2.61, p=0.005), and miscellaneous surgical complications (OR: 1.69, p=0.02). Moreover, CRP was associated with longer stay (OR: 1.07, p=0.01) and higher total hospital charges ($810 more per surgery, p=0.0004). Intra- and postoperative complications associated with CRP are higher than those of nmRP. Similarly, an increase in total hospital charges is associated with CRP. Nonetheless, CRP complication profile validates its safety and feasibility. PATIENT SUMMARY: In this population-based study, we recorded higher intra- and postoperative complications rates for CRP versus nmRP. Nonetheless, CRP complication rates appear manageable but require explicit discussion at counseling.
Cytoreductive radical prostatectomy (CRP) may offer a survival advantage, according to several retrospective analyses. However, few data are available regarding the morbidity of radical prostatectomy in the metastatic setting. We addressed intra- and postoperative complications of CRP relative to radical prostatectomy for nonmetastatic prostate cancer (nmRP). Within the National Inpatient Sample database (2008-2013), we identified patients who underwent CRP versus nmRP. Propensity score matching to reduce the effect of inherent differences between CRP and nmRP patients, multivariable logistic regression models, Poisson regression models, and linear regression models were used. Of 76 378 patients, 1.2% (n=953) underwent CRP. CRP resulted in higher rates of overall (odds ratio [OR]: 1.34, p=0.01), intraoperative (OR: 2.61, p=0.005), and miscellaneous surgical complications (OR: 1.69, p=0.02). Moreover, CRP was associated with longer stay (OR: 1.07, p=0.01) and higher total hospital charges ($810 more per surgery, p=0.0004). Intra- and postoperative complications associated with CRP are higher than those of nmRP. Similarly, an increase in total hospital charges is associated with CRP. Nonetheless, CRP complication profile validates its safety and feasibility. PATIENT SUMMARY: In this population-based study, we recorded higher intra- and postoperative complications rates for CRP versus nmRP. Nonetheless, CRP complication rates appear manageable but require explicit discussion at counseling.