Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece.
Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Urol. 2015 Jan;193(1):117-25. doi: 10.1016/j.juro.2014.08.091. Epub 2014 Aug 23.
Lymph node dissection in patients with prostate cancer may increase complications. An association of lymph node dissection with thromboembolic events was suggested. We compared the incidence and investigated predictors of deep venous thrombosis and pulmonary embolism among other complications in patients who did or did not undergo lymph node dissection during open and robot-assisted laparoscopic radical prostatectomy.
Included in study were 3,544 patients between 2008 and 2011. The cohort was derived from LAPPRO, a multicenter, prospective, controlled trial. Data on adverse events were extracted from patient completed questionnaires. Our primary study outcome was the prevalence of deep venous thrombosis and/or pulmonary embolism. Secondary outcomes were other types of 90-day adverse events and causes of hospital readmission.
Lymph node dissection was performed in 547 patients (15.4%). It was associated with eightfold and sixfold greater risk of deep venous thrombosis and pulmonary embolism events compared to that in patients without lymph node dissection (RR 7.80, 95% CI 3.51-17.32 and 6.29, 95% CI 2.11-18.73, respectively). Factors predictive of thromboembolic events included a history of thrombosis, pT4 stage and Gleason score 8 or greater. Open radical prostatectomy and lymph node dissection carried a higher risk of deep venous thrombosis and/or pulmonary embolism than robot-assisted laparoscopic radical prostatectomy (RR 12.67, 95% CI 5.05-31.77 vs 7.52, 95% CI 2.84-19.88). In patients without lymph node dissection open radical prostatectomy increased the thromboembolic risk 3.8-fold (95% CI 1.42-9.99) compared to robot-assisted laparoscopic radical prostatectomy. Lymph node dissection induced more wound, respiratory, cardiovascular and neuromusculoskeletal events. It also caused more readmissions than no lymph node dissection (14.6% vs 6.3%).
Among other adverse events we found that lymph node dissection during radical prostatectomy increased the incidence of deep venous thrombosis and pulmonary embolism. Open surgery increased the risks more than robot-assisted surgery. This was most prominent in patients who were not treated with lymph node dissection.
前列腺癌患者的淋巴结清扫可能会增加并发症。有研究表明，淋巴结清扫与血栓栓塞事件有关。我们比较了在开放性和机器人辅助腹腔镜前列腺根治性切除术期间行或不行淋巴结清扫的患者中深静脉血栓形成和肺栓塞等其他并发症的发生率，并探讨了其预测因素。
本研究纳入了 2008 年至 2011 年的 3544 例患者。该队列来自 LAPPRO，一项多中心、前瞻性、对照试验。从患者完成的问卷中提取不良事件数据。我们的主要研究结果是深静脉血栓形成和/或肺栓塞的患病率。次要结果是 90 天内其他类型的不良事件和住院再入院的原因。
547 例（15.4%）患者行淋巴结清扫术。与未行淋巴结清扫术的患者相比，行淋巴结清扫术的患者深静脉血栓形成和肺栓塞的风险增加了 8 倍和 6 倍（RR 7.80，95%CI 3.51-17.32 和 6.29，95%CI 2.11-18.73）。血栓栓塞事件的预测因素包括血栓形成史、pT4 期和 Gleason 评分 8 或更高。开放性前列腺根治术和淋巴结清扫术与机器人辅助腹腔镜前列腺根治术相比，深静脉血栓形成和/或肺栓塞的风险更高（RR 12.67，95%CI 5.05-31.77 vs 7.52，95%CI 2.84-19.88）。在未行淋巴结清扫术的患者中，开放性前列腺根治术使血栓栓塞风险增加 3.8 倍（95%CI 1.42-9.99），与机器人辅助腹腔镜前列腺根治术相比。淋巴结清扫术导致更多的伤口、呼吸、心血管和神经肌肉骨骼事件。与未行淋巴结清扫术相比，它导致更多的再入院（14.6%vs6.3%）。
在其他不良事件中，我们发现前列腺根治性切除术中的淋巴结清扫增加了深静脉血栓形成和肺栓塞的发生率。开放性手术比机器人辅助手术增加了更多的风险。在未行淋巴结清扫术的患者中，这种情况最为明显。
