Abstract
To investigate factors associated with the risk of major complications after radical prostatectomy (RP) by the open (ORP) or robot-assisted (RARP) approach for prostate cancer (PCa) in a tertiary referral center. 1062 consecutive patients submitted to RP were prospectively collected. The following outcomes were addressed: (1) overall postoperative complications: subjects with Clavien-Dindo System (CD) one through five versus cases without any complication; (2) moderate to major postoperative complications: cases with CD < 2 vs. ≥ 2, and 3) major post-operative complications: subjects with CDS CD ≥ 3 vs. < 3. The association of pre-operative and intra-operative factors with the risk of postoperative complications was assessed by the logistic regression model. Overall, complications occurred in 310 out of 1062 subjects (29.2%). Major complications occurred in 58 cases (5.5%). On multivariate analysis, major complications were predicted by PCa surgery and intraoperative estimated blood loss (EBL). ORP compared to RARP increased the risk of major CD complications from 2.8 to 19.3% (OR = 8283; p < 0.0001). Performing ePLND increased the risk of major complications from 2.4 to 7.4% (OR = 3090; p < 0.0001). Assessing intraoperative blood loss, the risk of major postoperative complications was increased by BL above the third quartile when compared to subjects with intraoperative blood loss up to the third quartile (10.2% vs. 4.6%; OR = 2239; 95%CI: 1233–4064). In the present cohort, radical prostatectomy showed major postoperative complications that were independently predicted by the open approach, extended lymph-node dissection, and excessive intraoperative blood loss.
Highlights
Prostate cancer (PCa) is the most commonly diagnosed tumor and the second leading cause of death from cancer in men [1]
Journal of Robotic Surgery for the management of clinically localized PCa, radical prostatectomy (RP) is one of the most commonly selected treatment options that can be delivered by the open (ORP) or robot-assisted (RARP) approach [2]
The aim of this study is to investigate the risk factors associated with major postoperative complications after ORP or RARP in a tertiary referral center
Summary
Prostate cancer (PCa) is the most commonly diagnosed tumor and the second leading cause of death from cancer in men [1]. Journal of Robotic Surgery for the management of clinically localized PCa, radical prostatectomy (RP) is one of the most commonly selected treatment options that can be delivered by the open (ORP) or robot-assisted (RARP) approach [2]. Prostate cancer surgery exposes patients to the risk of post-operative complications which can be classified according to Clavien–Dindo (CD) system [3, 4]. Predictors of postoperative complications may have a pivotal role in the planning of general activity and anticipating the costs to operate a urological unit [5]. The aim of this study is to investigate the risk factors associated with major postoperative complications after ORP or RARP in a tertiary referral center
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