30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity

Alibhai, Shabbir M.H.; Leach, Marc; Tomlinson, George; Krahn, Murray; Fleshner, Neil; Holowaty, Eric J.; Naglie, Gary

doi:10.1093/jnci/dji313

Cited by 183 publications

(109 citation statements)

References 36 publications

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“…When only the primary procedure during a hospitalization is evaluated, complete agreement is reported in greater than 99% of cases. 102,106 …”

Section: Renal Transplantationmentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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“…When only the primary procedure during a hospitalization is evaluated, complete agreement is reported in greater than 99% of cases. 102,106 …”

Section: Renal Transplantationmentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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show abstract

“…As one example, the guideline makes repeated reference to a perioperative mortality rate for radical prostatectomy of 0.5 % [3•, 6]. The citations for this figure are papers reporting the experience in Medicare (thus limited to older patients and generally representing low-volume surgeons) for open surgery in the mid-1990s [27,28].…”

Section: Who Is Screened? Who Is Treated?mentioning

confidence: 99%

Implications of the New AUA Guidelines on Prostate Cancer Detection in the U.S.

Cooperberg

2014

Curr Urol Rep

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In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a blanket "D" recommendation against all prostate-specific antigen (PSA)-based early detection efforts for prostate cancer, reflecting critical misinterpretations of the major evidence regarding benefits and harms of such testing. Against the backdrop of the ensuing controversy, in 2013 the American Urological Association (AUA) published a new, methodologically rigorous guideline. This guideline recommended that men aged 55-69 be offered biennial screening in the setting of shared decision-making, that men under 40 or over 69 years of age should not be screened routinely, and that evidence was insufficient to recommend screening for men aged 40-54 years. While it has received criticism with regard to the age-based recommendations, the AUA guideline reflects a far better and more balanced presentation of the available evidence than the USPSTF statement. However, because the USPSTF is far more influential than the AUA among primary care providers, the ultimate impact of the new AUA guideline on practice patterns may be limited. Optimizing early detection practices should involve consensusbuilding incorporating both primary care and specialist input, with the goals of minimizing overtreatment of low-risk disease while continuing to reduce prostate cancer mortality rates through early detection and aggressive management of highrisk disease.

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“…In a series of 11 010 prostatectomy patients examining short-term morbidity and mortality, Alibhai et al 50 found at least one complication (cardiovascular, respiratory, vascular, wound and/or genitourinary) within 30 days of surgery in 19.9% of patients. Men who had more comorbidities at the time of surgery, including cardiovascular disease (CVD), diabetes, obesity and chronic obstructive pulmonary disease, had an increased risk for every category of complications as well as 30-day mortality, independent of age.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Exercise therapy across the prostate cancer continuum

Antonelli

Freedland

Jones

2009

Prostate Cancer Prostatic Dis

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Exercise has been increasingly investigated as an adjunct therapy for cancer patients. The purpose of this paper is to comprehensively review the literature regarding exercise as a therapeutic adjunct for prostate cancer (PC). Several studies in patients with PC have shown quality of life improvements associated with exercise. Although no study has established the effect of exercise as a monotherapy for PC, the molecular mechanisms responsible for the potential association between exercise and PC are being elucidated. Given the low-risk, high-reward nature of these studies, further investigations are needed to better define the function of exercise along the PC continuum.

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30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity

Abstract: Increasing comorbidity is a stronger predictor than age of almost all categories of early complications after radical prostatectomy. The risk of postoperative mortality after radical prostatectomy is relatively low for otherwise healthy older men up to age 79.

Cited by 183 publications

References 36 publications

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Implications of the New AUA Guidelines on Prostate Cancer Detection in the U.S.

Exercise therapy across the prostate cancer continuum

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