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Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis
Mudassir Wani1, Abdullah Al-Mitwalli1, Subhabrata Mukherjee2
1Department of Urology, Swansea Bay University Health Board, Swansea SA6 6NL, UK.
Journal of Clinical Medicine
|June 28, 2023
Summary
Radical prostatectomy (RP) patients experience a 1% incidence of venous thromboembolism (VTE). Minimally invasive surgery and avoiding pelvic lymph node dissection reduce VTE risk, suggesting prophylaxis may not be needed for all patients.
Area of Science:
- Urology
- Oncology
- Vascular Surgery
Background:
- Radical prostatectomy (RP) is a primary treatment for localized prostate cancer.
- Venous thromboembolism (VTE) is a known complication of major abdominopelvic surgery like RP.
- Current guidelines lack consensus on VTE prophylaxis in urological procedures.
Purpose of the Study:
- To systematically review and meta-analyze VTE occurrence in post-RP patients.
- To assess the impact of surgical approach, pelvic lymph node dissection (PLND), and prophylaxis type on VTE risk.
- To identify VTE incidence and risk factors in patients undergoing RP.
Main Methods:
- A comprehensive literature search was conducted.
- Data from 16 studies were included for quantitative analysis.
- The DerSimonian-Laird random effects model was used for statistical analysis.
Main Results:
- The overall incidence of VTE after radical prostatectomy was found to be 1%.
- Minimally invasive surgical approaches (laparoscopic, robotic) were associated with a lower risk of VTE.
- RP performed without pelvic lymph node dissection (PLND) also showed a reduced risk of VTE.
Conclusions:
- Minimally invasive surgery and omitting PLND may decrease VTE risk in RP patients.
- Routine combined pharmacological and mechanical prophylaxis may not be necessary for all patients.
- VTE prophylaxis should be individualized, focusing on high-risk patients undergoing radical prostatectomy.
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