Thromboembolic Complications in 3,544 Patients Undergoing Radical Prostatectomy with or without Lymph Node Dissection

No AccessJournal of UrologyAdult Urology1 Jan 2015Thromboembolic Complications in 3,544 Patients Undergoing Radical Prostatectomy with or without Lymph Node Dissection Stavros I. Tyritzis, Anna Wallerstedt, Gunnar Steineck, Tommy Nyberg, Jonas Hugosson, Anders Bjartell, Ulrica Wilderäng, Thordis Thorsteinsdottir, Stefan Carlsson, Johan Stranne, Eva Haglind, Nils Peter Wiklund, and LAPPRO Steering Committee† Stavros I. TyritzisStavros I. Tyritzis Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece , Anna WallerstedtAnna Wallerstedt Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden , Gunnar SteineckGunnar Steineck 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 , Tommy NybergTommy Nyberg Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden , Jonas HugossonJonas Hugosson Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden , Anders BjartellAnders Bjartell Department of Urology, Skåne University Hospital, Malmö, Sweden Department of Oncology, Lund University, Lund, Sweden , Ulrica WilderängUlrica Wilderäng Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden , Thordis ThorsteinsdottirThordis Thorsteinsdottir 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 , Stefan CarlssonStefan Carlsson Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden , Johan StranneJohan Stranne Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden , Eva HaglindEva Haglind Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden , Nils Peter WiklundNils Peter Wiklund Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden , and LAPPRO Steering Committee† View All Author Informationhttps://doi.org/10.1016/j.juro.2014.08.091AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. References 1 : Complications of pelvic lymph node dissection for prostate cancer. Curr Urol Rep2011; 12: 203. Google Scholar 2 : Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications—a systematic review of the literature. Eur Urol2014; 65: 7. Google Scholar 3 : Heparin prophylaxis and the risk of venous thromboembolism after robotic-assisted laparoscopic prostatectomy. BJU Int2011; 108: 729. Google Scholar 4 : Venous thromboembolism in radical prostatectomy: is heparinoid prophylaxis warranted?. BJU Int2005; 96: 1019. Google Scholar 5 : Does heparin prophylaxis reduce the risk of venous thromboembolism in patients undergoing robot-assisted prostatectomy?. J Endourol2013; 27: 800. Google Scholar 6 : Blood type, lymphadenectomy and blood transfusion predict venous thromboembolic events following radical prostatectomy with pelvic lymphadenectomy. J Urol2014; 191: 646. Link, Google Scholar 7 : Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol2012; 62: 368. Google Scholar 8 : LAPPRO: a prospective multicentre comparative study of robot-assisted laparoscopic and retropubic radical prostatectomy for prostate cancer. Scand J Urol Nephrol2011; 45: 102. Google Scholar 9 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Google Scholar 10 : Complications of pelvic lymphadenectomy in 1,380 patients undergoing radical retropubic prostatectomy between 1993 and 2006. J Urol2008; 179: 923. Link, Google Scholar 11 : Thromboembolic complication rate after radical retropubic prostatectomy. Impact of routine ultrasonography for the detection of pelvic lymphoceles and hematomas. Eur Urol1998; 33: 86. Google Scholar 12 : Pelvic lymph node dissection is associated with symptomatic venous thromboembolism risk during laparoscopic radical prostatectomy. J Urol2011; 185: 1661. Link, Google Scholar 13 : Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy. Eur Urol2008; 53: 134. Google Scholar 14 : Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol2012; 62: 1. Google Scholar 15 : Perioperative outcomes for laparoscopic and robotic compared with open prostatectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urology2013; 82: 579. Google Scholar 16 : Thromboembolic events following surgery for prostate cancer. Eur Urol2013; 63: 354. Google Scholar 17 : Comparison of open and robot-assisted pelvic lymphadenectomy for prostate cancer. J Endourol2009; 23: 1313. Google Scholar 18 : Pelvic lymphadenectomy during robot-assisted radical prostatectomy: assessing nodal yield, perioperative outcomes, and complications. Urology2009; 74: 296. Google Scholar 19 : Comparison of lymph node yield in robot-assisted laparoscopic prostatectomy with that in open radical retropubic prostatectomy. BJU Int2011; 107: 1136. Google Scholar 20 : Assessment of lymph node yield after pelvic lymph node dissection in men with prostate cancer: a comparison between robot-assisted radical prostatectomy and open radical prostatectomy in the modern era. J Endourol2010; 24: 1055. Google Scholar 21 : Perioperative complications after radical prostatectomy: open versus robot-assisted laparoscopic approach. Urol Int2013; 90: 312. Google Scholar 22 : The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in the management of high-risk prostate cancer: a systematic review. Eur Urol2014; 65: 918. Google Scholar 23 : Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and pelvic lymph node dissection by bilateral peritoneal fenestration. World J Urol2008; 26: 581. Google Scholar 24 : Effect of mini-dose heparin on lymphocele formation following extraperitoneal pelvic lymphadenectomy. J Urol1980; 123: 890. Link, Google Scholar 25 : Patient-reported outcomes in randomised controlled trials of prostate cancer: methodological quality and impact on clinical decision making. Eur Urol2014; 66: 416. Google Scholar 26 : Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity?. BJU Int2011; 108: 372. Google Scholar 27 : Robot-assisted laparoscopic prostatectomy: nodal dissection results during the first 440 cases by two surgeons. J Endourol2012; 26: 1618. Google Scholar 28 : Outcomes and complications of pelvic lymph node dissection during robotic-assisted radical prostatectomy. World J Urol2013; 31: 481. Google Scholar 29 : Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology2010; 75: 1092. Google Scholar 30 : A hierarchical step-model for causation of bias-evaluating cancer treatment with epidemiological methods. Acta Oncol2006; 45: 421. Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChang P, Wagner A, Regan M, Smith J, Saigal C, Litwin M, Hu J, Cooperberg M, Carroll P, Klein E, Kibel A, Andriole G, Han M, Partin A, Wood D, Crociani C, Greenfield T, Patil D, Hembroff L, Davis K, Stork L, Spratt D, Wei J and Sanda M (2021) Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 ConsortiumJournal of Urology, VOL. 207, NO. 1, (127-136), Online publication date: 1-Jan-2022.Cimen H, Atik Y, Saitz T and Serefoglu E (2016) The Accuracy of References in The Journal of Urology®Journal of Urology, VOL. 195, NO. 6, (1952-1955), Online publication date: 1-Jun-2016. Volume 193Issue 1January 2015Page: 117-125 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordslymph node excisionpulmonary embolismprostatectomyprostatevenous thrombosisMetricsAuthor Information Stavros I. Tyritzis Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece More articles by this author Anna Wallerstedt Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden More articles by this author Gunnar Steineck 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 More articles by this author Tommy Nyberg Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden More articles by this author Jonas Hugosson Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden More articles by this author Anders Bjartell Department of Urology, Skåne University Hospital, Malmö, Sweden Department of Oncology, Lund University, Lund, Sweden More articles by this author Ulrica Wilderäng Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden More articles by this author Thordis Thorsteinsdottir 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 More articles by this author Stefan Carlsson Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden More articles by this author Johan Stranne Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden More articles by this author Eva Haglind Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden More articles by this author Nils Peter Wiklund Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden More articles by this author LAPPRO Steering Committee† Eva Haglind, Principal Investigator; Gunnar Steineck, Deputy Principal Investigator; Bo Anderberg, Department of Surgery, St. Görans Hospital and Ingela Björholt, Nordic Health Economics, Göteborg; Thomas Jiborn, Department of Urology, Skåne University Hospital and Lund University; Jan-Erik Damber and Ali Khatami, Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg; Mikael Wulkner-Sylmé, Department of Urology, Varberg Hospital; Christer Edlund, Department of Surgery, Kungsbacka Hospital; Erik Pileblad, Capio Lundby Hospital; Hans Boman, Department of Surgery, Alingsås Hospital; Ola Bratt, Department of Urology, Helsingborg Hospital; and Ulrika Westlund, Department of Urology, Södersjukhuset. 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