Thromboembolic complications in 3,544 patients undergoing radical prostatectomy with or without lymph node dissection

Area of Science:

• Urology
• Surgical Oncology
• Vascular Surgery

Background:

• Lymph node dissection (LND) is a standard procedure in prostate cancer treatment.
• Potential complications of LND, including thromboembolic events, warrant further investigation.
• The comparative risk of LND during open versus robot-assisted radical prostatectomy (RARP) is not fully elucidated.

Purpose of the Study:

• To compare the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing radical prostatectomy with or without LND.
• To investigate predictors of DVT and PE following radical prostatectomy.
• To evaluate the impact of surgical approach (open vs. RARP) on DVT/PE risk in conjunction with LND.

Main Methods:

• A cohort of 3,544 patients from the LAPPRO trial (2008-2011) was analyzed.
• Data on adverse events, including DVT and PE, were collected via patient questionnaires.
• Primary outcome was the prevalence of DVT/PE; secondary outcomes included other adverse events and readmissions.

Main Results:

• LND was performed in 15.4% of patients and was associated with significantly higher risks of DVT (RR 7.80) and PE (RR 6.29).
• Predictors for thromboembolic events included a history of thrombosis, pT4 stage, and Gleason score ≥8.
• Open radical prostatectomy with LND showed a higher DVT/PE risk compared to RARP with LND. Open surgery without LND also increased thromboembolic risk compared to RARP without LND.

Conclusions:

• Lymph node dissection during radical prostatectomy increases the incidence of DVT and PE.
• Open radical prostatectomy is associated with higher thromboembolic risks than robot-assisted surgery, particularly when LND is performed.
• LND also led to increased rates of other complications and hospital readmissions.