Predictors of complications occurring after open and robot-assisted prostate cancer surgery: a retrospective evaluation of 1062 consecutive patients treated in a tertiary referral high volume center

Abstract

To investigate factors associated with the risk of major complications after radical prostatectomy (RP) by the open (ORP) or robot-assisted (RARP) approach for prostate cancer (PCa) in a tertiary referral center. 1062 consecutive patients submitted to RP were prospectively collected. The following outcomes were addressed: (1) overall postoperative complications: subjects with Clavien-Dindo System (CD) one through five versus cases without any complication; (2) moderate to major postoperative complications: cases with CD < 2 vs. ≥ 2, and 3) major post-operative complications: subjects with CDS CD ≥ 3 vs. < 3. The association of pre-operative and intra-operative factors with the risk of postoperative complications was assessed by the logistic regression model. Overall, complications occurred in 310 out of 1062 subjects (29.2%). Major complications occurred in 58 cases (5.5%). On multivariate analysis, major complications were predicted by PCa surgery and intraoperative estimated blood loss (EBL). ORP compared to RARP increased the risk of major CD complications from 2.8 to 19.3% (OR = 8283; p < 0.0001). Performing ePLND increased the risk of major complications from 2.4 to 7.4% (OR = 3090; p < 0.0001). Assessing intraoperative blood loss, the risk of major postoperative complications was increased by BL above the third quartile when compared to subjects with intraoperative blood loss up to the third quartile (10.2% vs. 4.6%; OR = 2239; 95%CI: 1233–4064). In the present cohort, radical prostatectomy showed major postoperative complications that were independently predicted by the open approach, extended lymph-node dissection, and excessive intraoperative blood loss.

American Society of Anesthesiologists’ (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients

“…These associations may be explained by considering the pathophysiology of the stress system, which is not the same along the ASA groups, that is called to withstand the impact of both anesthesia and surgery on the physical system. Higher levels of stress, increased BMI, surgical approach are features impacting on major complications, which will delay LOHS with drawbacks on both economical and biological costs [26][27][28][29]. Indeed, along the hypothalamic pituitary adrenal axis, pathways of the stress system are triggered to a lesser degree by RARP compared with ORP; as such, postoperative recovery is faster for the former [28].…”

The ‘prostate-muscle index’: a simple pelvic cavity measurement predicting estimated blood loss and console time in robot-assisted radical prostatectomy

“…Our study has several limitations. First, the present study was conducted in a Japanese male population of which the prostate size was relatively smaller than those of Western countries 28 , 29 . However, the median preoperative prostate size was 28.5cm3 which was in line with the results of other Japanese cohorts 30 – 32 .…”

Cardiovascular Disease and Chronic Pulmonary Disease Increase the Risk of Short-Term Major Postoperative Complications after Robotic-Assisted Radical Prostatectomy

“…Postoperative complications after RARP may not just impact patients' well-being but also prolong inpatient stays [7,8]. In addition to intraoperative factors, such as estimated blood loss, as well as pelvic lymph node dissection (PLND) [9], preoperative factors, such as a patient's age; American Society of Anesthesiologists (ASA)'s physical status; body mass index (BMI); lymph node invasion; and neoadjuvant therapy, are likely to affect the rates of postoperative complications after radical prostatectomy [8,[10][11][12][13][14]. In an aging society, comorbidities and a history of complex medical conditions are of major importance in cancer and non-cancer patients [15].…”