You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 20101951 PELVIC LYMPH NODE DISSECTION IS ASSOCIATED WITH VENOUS THROMBOEMBOLISM RISK DURING LAPAROSCOPIC RADICAL PROSTATECTOMY John Eifler, Adam Levinson, Patrick Walsh, and Christian Pavlovich John EiflerJohn Eifler More articles by this author , Adam LevinsonAdam Levinson More articles by this author , Patrick WalshPatrick Walsh More articles by this author , and Christian PavlovichChristian Pavlovich More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1940AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Venous thrombo-embolism (VTE) is a source of serious morbidity and mortality after radical prostatectomy (RP). Pelvic lymph node dissection (PLND), traditionally a routine part of RP, may be related to the development of VTE. Given that PLND may not always be necessary, we wondered whether omitting PLND would decrease the incidence of VTE. METHODS The records of 773 consecutive patients who underwent laparoscopic radical prostatectomy (LRP) by a single surgeon from 2001-2009 were reviewed for postoperative VTE. All patients underwent transperitoneal or extraperitoneal LRP +/- standard (obturator and external iliac) PLND and had a minimum of 3 months of follow-up. Only patients at increased risk for lymph node metastasis by Partin nomogram (>1%), patients with high volume disease on biopsy, and patients who requested PLND received it. RESULTS 469 patients (60.7%) underwent LRP+PLND; 304 underwent LRP only (39.3%). VTE occurred in 7/469 LRP+PLND patients (1.5%), and in 0/304 LRP-only patients (0%) (p=0.046). Elevated BMI was associated with VTE in patients undergoing PLND (p=0.006 by ANOVA). Whereas patients with BMI < 30.0 had a 0.8% chance of developing VTE, patients with BMI ≥ 30.0 had a 5.5% chance of developing VTE and those with BMI ≥ 32.5 had a 13.6% chance of VTE. Patients who underwent LRP+PLND and developed VTE had a trend toward longer operative times (3.7 vs. 3.2 hrs, p=0.16) and larger prostate volumes (58.4 vs. 49.9, p=0.12), but similar lymph node counts (5.9 vs. 5.7) as those who underwent LRP+PLND and did not develop VTE. Surgical approach (extra- or trans-peritoneal) and cancer stage were not risk factors for VTE. Only 4/469 (0.9%) men had positive lymph nodes. CONCLUSIONS PLND during LRP may increase the risk of VTE without providing an obvious cancer control benefit in most patients with clinically localized prostate cancer. Patients with elevated BMI are especially at risk. Our data argue that PLND should be judiciously rather than routinely performed on patients at extremely low risk for LN metastasis. Baltimore, MD© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e758 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Eifler More articles by this author Adam Levinson More articles by this author Patrick Walsh More articles by this author Christian Pavlovich More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...