Comparison of Perioperative Outcomes Between Cytoreductive Radical Prostatectomy and Radical Prostatectomy for Nonmetastatic Prostate Cancer

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 summaryIn 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.