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Updated: Apr 30, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Standardized report for early complications of radical prostatectomy
Wei-Ming Cheng1, Tzu-Ping Lin2, Chih-Chieh Lin2
1Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Background:
Radical prostatectomy (RP) is one of the curative treatment options for patients with prostate cancer to achieve long-term survival, but it is accompanied by potential complications. The Martin criteria used as a format for reporting complications has become standard in recent years. However, it has not been applied in RP in Asian countries. In the present study, we investigated the early complications of RP developing within 90 days in our institute according to the Martin criteria.
Methods:
Between January 2003 and November 2011, patients with organ-confined adenocarcinoma of the prostate who received RP in our institute were retrospectively reviewed. The operation was done as open RP, or minimally invasive RP, including laparoscopic RP and robot-assisted laparoscopic RP (RaLP). The preoperative, operative, postoperative, and pathological parameters were recorded for analysis. Definitions of complications were adopted from previous reports. Surgical and medical complications developed within 90 days postoperatively were identified respectively; severity of each complication was classified according to Clavien-Dindo classification. Clavien-Dindo classification grade III or higher complications were viewed as major complications.
Results:
A total of 359 patients were included; 280 (78%) underwent open RP, 45 (12.5%) received laparoscopic RP, and 34 (9.5%) had RaLP. The overall complication rate was 40.1%, and the major complication rate was 13.1%. There was no surgical mortality. Diarrhea requiring conservative treatment (13.6%), minor urine leakage (9.5%), and gout attack (4.2%) were the leading complications. Minimally invasive RP had higher rates of lymph leakage (p = 0.015) and upper-extremity neuropathy (p = 0.048). Body mass index >25 kg/m(2) and use of neoadjuvant hormone therapy were predictors for overall and major complications, whereas diabetes mellitus also predicted the development of major complications. Besides lower case volume and learning curve for RaLP, patients' higher age at surgery and higher risk for disease progression compared to the Western series may be responsible for the higher complication rates.
Conclusion:
The early complication rates of RP in our patients were slightly high compared to the Western series. By standardized report, being overweight, diabetes mellitus, and use of neoadjuvant hormone therapy were identified as predictors of early complications in our series.
Insights
Radical prostatectomy (RP) complications within 90 days were analyzed using the Martin criteria. Overweight patients, those with diabetes, and those receiving neoadjuvant hormone therapy faced higher risks.
Area of Science:
- Urology
- Surgical Oncology
- Patient Safety
Background:
- Radical prostatectomy (RP) offers long-term survival for prostate cancer but carries risks.
- The Martin criteria standardize complication reporting but are underutilized in Asian RP studies.
- This study evaluated early RP complications in an Asian cohort using the Martin criteria.
Purpose of the Study:
- To assess the incidence and types of early complications following radical prostatectomy (RP) within 90 days.
- To apply the Martin criteria for standardized reporting of RP complications in an Asian population.
- To identify predictors of early complications after RP.
Main Methods:
- Retrospective review of 359 patients undergoing open, laparoscopic, or robot-assisted radical prostatectomy (RaLP) between 2003-2011.
- Complications were identified within 90 days and graded using the Clavien-Dindo classification.
- Preoperative, operative, and pathological data were analyzed to determine complication predictors.
Main Results:
- Overall complication rate was 40.1%, with major complications at 13.1%; no surgical mortality occurred.
- Leading complications included diarrhea (13.6%), minor urine leakage (9.5%), and gout attack (4.2%).
- Minimally invasive RP showed higher rates of lymph leakage and upper-extremity neuropathy. Overweight, neoadjuvant hormone therapy, and diabetes mellitus predicted complications.
Conclusions:
- Early complication rates in this Asian cohort were higher than Western series.
- Standardized reporting identified overweight, diabetes mellitus, and neoadjuvant hormone therapy as key predictors.
- These findings highlight the need for tailored management strategies in Asian patients undergoing RP.
