The Incidence And Predictors Of Complications Of Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 19 Sep 2008 - 7:00 PDT

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BERLIN, GERMANY (UroToday.com) - Dr. Farhang Rabbani, Attending Surgeon, Memorial Sloan Kettering Cancer Center (MSKCC), presented a comprehensive review of the complications associated with radical prostatectomy. His review of 4,698 men operated on at MSKCC from January 1999 - June 2007 presented benchmarks for outcome, serves as an important baseline, and will perhaps serve to alter our informed consent. The review was limited by a relatively low number of patients undergoing robotic assisted laparoscopic prostatectomy but did include a large number of patients undergoing both open and pure laparoscopic surgery.

3,465 (74%) men underwent an open radical retropubic prostatectomy (ORP) and 1,134 (24%) were performed laparoscopically (LRP), including 96 done with robotic assistance. As expected, the complication profiles for laparoscopic and open surgery are distinct. The incidence of hemorrhage for the entire population, defined as greater than 2500 ml blood loss, 6.1%, and was rarer during laparoscopic procedure, p<0.001. The mean ORP blood loss was 1286 ml and the mean LRP blood loss was 313 ml. In addition to the type of the surgery, statistically significant predictors of the volume of blood loss were operative duration (p<0.001, specimen weight (p<0.001), BMI (p=0.004) and ASA score (p=0.021).

For the entire cohort, urologic complications were the most common, 12.9%. The most common urologic complications were bladder neck contracture, 5.1%, urinoma or urine leak, 4.3%, urinary retention, 3.9%, urethral stricture, 1.1%, and hydronephrosis, 1.1%. The most common non-urologic surgical complications were lympho-vascular, 12.3%, infectious, 3.5% and wound, 3.3%, gastro-intestinal 1.8% and neurological, predominantly nerve palsies, 1.2%.

One hopes that this very comprehensive and candid review of the experience with radical prostatectomy from MSKCC will be published soon. As I indicated, the data will be very valuable in establishing benchmarks of surgical results.

Presented by Farhang Rabbani, MD, at the Annual Meeting of the American Urological Association - New York Section - September 6 - 13, 2008 - Berlin, Germany

Reported by UroToday.com Contributing Editor Mitchell C. Benson, MD

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