BACKGROUND: Lymph node dissection (LND) in prostate cancer patients may increase complications.
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An association of LND with thromboembolic events has been suggested. We compared the incidence and investigated predictors of deep venous thrombosis (DVT) and pulmonary embolism (PE) among other complications in patients undergoing or not undergoing LND during open (ORP) and robot-assisted laparoscopic radical prostatectomy (RARP).
METHODS: 3544 patients were included between 2008-2011. The cohort derives from LAPPRO, a multi-center, prospective controlled trial. Data concerning adverse events were extracted from patient-completed questionnaires. Our primary outcome was prevalence of DVT and/or PE. Secondary outcomes were other types of 90-day adverse events and re-admission causes.
RESULTS: 547 (15.4%) patients underwent LND. LND was associated with an 8-fold and 6-fold higher risk of DVT and PE events, respectively, compared to the no-LND patients (RR 95%CI: 7.80 (3.51-17.32) and 6.29 (2.11-18.73)). Predictive factors for thromboembolic events included a previous history of thrombosis, pT4 stage, Gleason score ≥8. ORP and LND had a higher risk of DVT and/or PE (RR 95%CI: 12.67 (5.05-31.77) versus 7.52 (2.84-19.88) in RARP). In no-LND patients, ORP increased 3.8-fold the thromboembolic risk compared to RARP (95%CI 1.42-9.99). LND induced more wound, respiratory, cardiovascular and neuromusculoskeletal events. LND caused more re-admissions compared to no-LND (14.6% vs. 6.3%).
CONCLUSIONS: Among other adverse events, we found that LND during radical prostatectomy increased the occurrence of DVT and PE. Open surgery increased the above risk more than robot-assisted surgery; this was most prominent in patients not undergoing LND.
Tyritzis SI, Wallerstedt A, Steineck G, Nyberg T, Hugosson J, Bjartell A, Wilderäng U, Thorsteinsdottir T, Carlsson S, Stranne J, Haglind E, Wiklund NP. Are you the author?
Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet; Center for Minimally Invasive Urological Surgery, Athens Medical Center; Division of Clinical Cancer Epidemiology, Karolinska Institutet; Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg; Division of Clinical Cancer Epidemiology, Karolinska Institutet; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg; Department of Urology, Skåne University Hospital; Department of Oncology, Lund University; Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg; Faculty of Nursing, University of Iceland; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg.
Reference: J Urol. 2014 Aug 22. pii: S0022-5347(14)04267-0.