EAU 2018: Prostate Cancer: Immediate and Late Complications - Laparoscopic

Copenhagen, Denmark (UroToday.com) Intraoperative complications in laparoscopic radical prostatectomy (LRP) has been reported to occur in 1.6% +/-1.9 of cases, while perioperative complications occur in – 11.1%+/- 9.6% of cases. Complications of LRP can occur due to the learning curve, patient positioning, approach, bleeding, hemorrhage and CO2 embolism, anastomosis, and pelvic lymph node dissection (PLND).

Ocular complications can occur in laparoscopic surgeries. Specifically, posterior ischemic optic neuropathy (PION) can occur due to the Trendelenburg position, anesthesiologic factors, and patient’s characteristics. PION can result perioperative visual loss (0.02-0.1%).

Antegrade LRP has been shown to harbor less complications compared to the posterior approach. The anterior approach has significantly lower rates of blood loss, and less need for transfusions, lower mean anastomosis time, and reduced mean hospitalization time.

CO2 embolus can occur due to misplacement of the Veress needle, lesion of a large vein together with pneumoperitoneum. It is manifested with hypotension, hypoxemia, millwheel murmur, arrhythmia, pulmonary edema, and right ventricular distension. Subclinical gas embolisms occur in 17.1% of LRP cases.

Intravescial hemolock clip migration after LRP is associated with 3 causes:

  1. Obstructive lower urinary tract symptoms
  2. Stone formations, gross hematuria, bladder spasm
  3. Spontaneous expulsion of the clip.
The use of hemolock clip adjacent to the anastomosis should be avoided at all costs.

Up to 50% of lymphoceles are asymptomatic, and 1.7%+/-1.2 are symptomatic, causing compression of veins, nerves and even cause infection. It is important to remove all the lymph nodes that are involved with cancer. Lymphocele is usually formed since lymph nodes not associated to the cancer were removed. In the transperitoneal approach, the exposure is better and there are less lymphoceles.

When compared to the LRP, the open radical prostatectomy (ORP) has a higher transfusion rate (20.8% vs. 2.7%, p<0.001), and higher anastomotic strictures (14% vs. 5.8%, p<0.01). Independent risk factors for anastomotic strictures include previous radiotherapy and TURP procedure.

In conclusions, there are plenty of potential complications in LRP, but in general the complication rate is low. Knowing the possible complications is a prerequisite to avoid them.

Presented by: Gunter Janetschek, Salsburg/Vienna, Austria

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark

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