San Diego, CA USA (UroToday.com) Radical prostatectomy is the most commonly performed treatment for localized prostate cancer in the United States. Rectal injury (RI) is a rare but significant complication of radical prostatectomy, which can lead to abscess formation, fistula, and sepsis. The incidence of RI ranges from 0.4% to 1.8%. Established risk factors include previous radiation, previous prostate or rectal surgery, and surgeon volume. Pearce and colleagues sought to perform the first study using a national database addressing the incidence and risk factors for RI.
The authors queried the National Inpatient Sample for patients who underwent radical prostatectomy for prostate cancer between 2003-2012. Patients with a diagnosis of rectal injury or rectal injury repair were identified. The authors also collected demographic data, and hospital characteristics, including volume of radical prostatectomies, as well as surgical details, complications and perioperative outcomes.
614,294 men who underwent radical prostatectomy between 2003- 2012 were identified. 2,900 (0.5%) rectal injuries were identified, 281 (10%) of which requiring colostomy. The authors noted a significantly decreased rate of rectal injuries over time, with an incidence of 0.6% in 2003 and 0.4% in 2012 (p= 0.02). However, they noted an increased rate of RI in open surgery, while rates following laparoscopic and robotic procedures have stayed stable (0.6%, 0.4% and 0.2% respectively, p< 0.01).
Patient characteristics associated with RI were older age (62 vs. 61.2 years in patients who did not experience RI, p< 0.01), African American race (0.8% vs. 0.4% in Caucasians, p< 0.01), and clinically significant benign prostatic hyperplasia or metastatic disease (all p< 0.05). There was a lower incidence of RI in obese men (p< 0.05). Hospital characteristics associated with RI were urban (0.8% vs. 0.5% for rural), non-teaching (0.6% vs. 0.4% for teaching), and low volume hospitals (0.6% vs 0.3% for high- volume, p< 0.1 for all). Finally RI was associated with increased complications rates (28% vs. 11%, length of stay (4.8 vs. 2.3 days) and total costs ($45,298 vs. 32,855, all p< 0.01). Logistic regression analysis revealed that African-American race, BPH and metastatic cancer were each independent predictors of risk for rectal injury. Private insurance, robotic approach, high-volume hostpital and obesity appeared to reduce risk for rectal injury.
The authors conclude that rectal injury is more common among African-American patients, patients with BPH or metastatic cancer, and low BMI. They are also more common following open surgical procedures and at urban, non-teaching, low-volume hospitals.
Presented By: Shane Pearce, MD
Written By: Simone Vernez; Medical Student, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA