Extended pelvic lymphadenectomy for prostate cancer: Will the previously reported benefits be reproduced in hospitals with lower surgical volumes?

Lindberg, Christian; Davidsson, Thomas; Guðjónsson, Sigurður; Hilmarsson, Rafn; Bratt, Ola

doi:10.1080/00365590903200524

Cited by 3 publications

(3 citation statements)

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“…Unless no regional variability in VTE instances within the United States is reported, the generalizability of the Florida Hospital Inpatient Datafile can also be questioned [35]; and although we noted that ASC is important, procedures other than RP or clinical pathways at institutions might be related to individual surgeon complication rates. Finally, since the extent of PLND is known to be associated with VTE, the lack of such information in the current study might have biased the results [36].…”

Section: Discussionmentioning

confidence: 87%

Venous thromboembolism after radical prostatectomy: the effect of surgical caseload

Schmitges¹,

Trinh²,

Sun³

et al. 2012

BJU International

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What ' s known on the subject? and What does the study add? Several risk factors increase VTE after RP: advanced age, comorbidities such as cardiopulmonary disease, rheumatologic diseases, prior history of VTE, more advanced prostate cancer, and simultaneous pelvic lymph node dissection. To date, the effect of annual surgical caseload (ASC), an established determinant of various RP outcomes, has not been tested. A previous study showed in adjusted analyses that patients operated for colorectal cancer by very high ASC surgeons were 60% less likely to suffer a VTE than those operated by low ASC surgeons. Moreover, some authors hypothesized that laparoscopy may contribute to a higher risk of VTE, due to peritoneal insuffl ation, reverse Trendelenburg position and prolonged operative time. The VTE rates reported in the current population-based study closely refl ect those reported in institutional series. Moreover, we validated the practice-makes-perfect concept, since ASC was linked to VTE. We could not detect statistically signifi cantly differences between minimally invasive radical prostatectomy (MIRP) patients and others. Our results indicate that lower rates of VTE should be expected in patients treated by high ASC surgeons. Our fi ndings suggest that VTE-specifi c processes of care need to be improved, with the intent of reaching the level recorded in patients treated by high ASC surgeons. Finally, MIRP seems to be no risk factor for VTE. OBJECTIVE• To examine the effect of annual surgical caseload (ASC) on the likelihood of venous thromboembolism (VTE) after radical prostatectomy (RP). PATIENTS AND METHODS• Between 1999 and 2008, 36 699 RPs were performed in the state of Florida. Logistic regression models predicting the likelihood of VTE were fi tted.• Covariates included year of surgery, age, race, baseline Charlson Comorbidity Index (CCI), lymph node dissection, ASC and surgical approach. RESULTS• The overall VTE rate was 0.3%. It was higher in patients operated within the low (0.4%) and intermediate (0.3%) ASC tertile than in those operated within the high-ASC tertile (0.1%, P < 0.001).• Mortality rate was 6.0% in patients with VTE vs 0.1% in others ( P < 0.001). Median length of stay and median total hospital charges were 9 vs 3 days ( P < 0.001) and $51 571 vs $24 943 ( P < 0.001) in patients with VTE vs others, respectively.• In multivariable analyses predicting VTE, patients operated on by low-ASC surgeons were at higher risk of VTE than those operated on by high-ASC surgeons (odds ratio [ OR ] = 3.78, P < 0.001). Additionally, black patients were more likely to experience a VTE (OR = 1.80, P = 0.023). Patients with CCI ≥ 1 were also more likely to experience a VTE than others (OR = 1.65, P = 0.016). Conversely, patients who had undergone minimally invasive radical prostatectomy were not more likely to experience a VTE than those who had undergone open RP (OR = 1.97, P = 0.086). CONCLUSIONS• RP by high-ASC surgeons exerts a protective effect on the likelihood of VTE.• Additionally, VTE is associated ...

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Section: Discussionmentioning

confidence: 87%

Venous thromboembolism after radical prostatectomy: the effect of surgical caseload

Schmitges¹,

Trinh²,

Sun³

et al. 2012

BJU International

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“…There are a number of factors affecting the prognosis of Pca, including general situation, tumor stage, tumor grade, iPSA, age and bone scintigraphy (32)(33)(34). Ciezki et al (24) reported that clinical stage T3, biopsy Gleason score 8-10, higher pretreatment PSA, shorter ADT duration and more frequent PSA testing following therapy were all associated with a significantly worse bRFS.…”

Section: Discussionmentioning

confidence: 99%

125I low‑dose‑rate prostate brachytherapy and radical prostatectomy in patients with prostate cancer

et al. 2019

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Radical prostatectomy (RP) and low-dose-rate prostate brachytherapy (LDR) are two widely used treatment options for patients with T1c-T3a prostate cancer. In the present study, the efficacy of the two treatments was compared. A total of 429 patients who underwent either LDR (n=218) or RP (n=211) between January 2010 and June 2015 were retrospectively reviewed. Biochemical relapse-free survival time (bRFS) and clinical relapse-free survival time (cRFS) were assessed. The log-rank test compared bRFS between the two modalities, and Cox regression identified factors associated with bRFS. The median follow-up time and patient age were 46.6 months and 71 years, respectively. The bRFS at 1, 2 and 5 years was 89.4, 87.2 and 79.9% for LDR, respectively, and 91.0, 82.8 and 72.2% for RP, respectively (P=0.077). The cRFS at 1, 2 and 5 years was 99.1, 97.7 and 94.9% for LDR, respectively, and 99.0, 96.2 and 94.5% for RP, respectively (P=0.630). It was indicated that LDR produced equivalent bRFS and cRFS rates compared with RP. The risk of biochemical failure (bF) was higher for the RP group compared with the LDR group in patients with a Gleason score ≤3+4 (P=0.022) or initial prostate specific antigen ≤10 ng/ml (P=0.002). Based on the univariate and multivariate logistic regression analysis of all 429 patients, T stage ≥T2b was an independent predictor for bF.

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“…There is controversy over the comparative safety profile of more extensive lymphadenectomy. Some centres have reported a higher complication rate with ELND compared with LLND [7,22], while other studies have not demonstrated a higher complication rate [21,23]. Winter et al…”

Section: Discussionmentioning

confidence: 99%

Standardized comparison of robot‐assisted limited and extended pelvic lymphadenectomy for prostate cancer

et al. 2013

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What's known on the subject? and What does the study add?• Extended pelvic lymphadenectomy is the present standard of care according to European Association of Urology guidelines. Extended dissection improves staging, removes more metastatic lymph nodes, and potentially has therapeutic benefits. Previous reports have examined the morbidity of extended dissection compared with a more limited dissection in the open and laparoscopic setting. While some have suggested an increased complication rate with extended node dissection, others have not.• This represents the first study focused on comparing the complications associated with the extent of node dissection using the modified Clavien system and Martin criteria in the literature on robot-assisted surgery. In a single surgeon series, we found no statistically significant differences in complications. With careful anatomic dissection, robot-assisted extended lymph node dissection can be performed safely and effectively, although operating time and length of hospital of stay are slightly increased. Objectives• To compare the perioperative course of patients undergoing robot-assisted limited lymph node dissection (LLND) or extended lymph node dissection (ELND) for prostate cancer.• To examine the differential lymph node counts and rates of detection of lymph node metastases. Patients and Methods• Between 2008 and 2012, 406 consecutive patients with D'Amico intermediate-or high-risk prostate cancer underwent either bilateral LLND (n = 204) or ELND (n = 202) and robot-assisted laparoscopic radical prostatectomy by a single surgeon. • The region of dissection was the obturator fossa for LLND, while ELND included, in addition, the common iliac, external iliac and internal iliac lymph nodes. • All complications within 90 days of surgery were recorded according to a modified Clavien system. • Clinical variables were summarized and compared. Logistic regression was used to identify predictors of complications. Results• There were no differences in demographics when comparing patients who underwent ELND with those who underwent LLND.• The median operating time was 3.0 h for the ELND cohort and 2.8 h in the LLND cohort (P < 0.001).Intraoperative blood loss was 200 mL in both cohorts. Hospital stay was longer for a small percentage of patients in the ELND cohort, with 75% of ELND patients and 85% of LLND patients staying 1 day (P = 0.004).• No significant difference was found in the overall or major complication rates between LLND (21.6% overall; 6.9% major) and ELND (22.8% overall; 4.5% major). No difference was seen in the symptomatic lymphocele rate between LLND and ELND, 2.9 vs 2.5%, respectively. • Overall, the lymph-node-positive rate was 12% compared with 4% for the ELND and LLND groups, respectively (P = 0.002).• A higher Charlson comorbidity index score was associated with the development of major complications. Conclusions• ELND at the time of robot-assisted radical prostatectomy can be performed safely with minimal additional morbidity.• Long-term oncological and fu...

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Extended pelvic lymphadenectomy for prostate cancer: Will the previously reported benefits be reproduced in hospitals with lower surgical volumes?

Cited by 3 publications

References 0 publications

Venous thromboembolism after radical prostatectomy: the effect of surgical caseload

Venous thromboembolism after radical prostatectomy: the effect of surgical caseload

125I low‑dose‑rate prostate brachytherapy and radical prostatectomy in patients with prostate cancer

Standardized comparison of robot‐assisted limited and extended pelvic lymphadenectomy for prostate cancer

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