Presentation Authors: Anna Lantz*, Stockholm, Sweden, Johan Stranne, Gothenburg, Sweden, Stavros Tyritzis, Stockholm, Sweden, David Bock, David Wallin, Hanna Nilsson, Gothenburg, Sweden, Stefan Carlsson, Stockholm, Sweden, Thordis Thorsteinsdottir, Reykawik, Iceland, Ove Gustafsson, Stockholm, Sweden, Jonas Hugosson, Gothenburg, Sweden, Anders Bjartell, Lund, Sweden, Peter Wiklund, Stockholm, Sweden, Gunnar Steineck, Eva Haglind, Gothenburg, Sweden
Introduction: All types of surgery are associated with complications. The debate is ongoing whether robot-assisted radical prostatectomy can lower this risk compared to open surgery. The objective of the present study was to evaluate postoperative adverse events leading to readmissions, using clinical records to classify these adverse events systematically.
Methods: A prospective controlled trial of men who underwent robot-assisted laparoscopic (RALP) or retropubic radical prostatectomy (RRP) at 14 departments of Urology (LAPPRO) between 2008 and 2011. The inclusion criteria were age < 75 yr, ability to read and write Swedish, informed consent, tumour stage cT1, cT2, or cT3 with no signs of distant metastases, and a prostate-specific antigen level of < 20 ng/ml. Primary outcome was postoperative adverse events leading to readmissions up to 3 months after surgery. Data on all readmissions within 3 months of surgery were collected from the Patient registry, Swedish Board of Health and Welfare. For each readmission the highest Clavien-Dindo grade was listed.
Results: A total of 4003 patients were included in the LAPPRO trial and after applying exclusion criteria 3706 patients remained for analyses. The results showed no statistically significant difference in the overall readmission rates (8.1 vs. 7.1%) or readmission due to major complications (Clavien-Dindo â‰¥ 3b, 1.7 vs. 1.9%) between RALP and RRP within 90 days after surgery. Patients subjected to lymph-node dissection (LND) had twice the risk for readmission as men not undergoing LND irrespective RALP or RRP technique. Blood transfusion was significantly more frequent during and within 30 days of RRP surgery (16 vs. 4%). Abdominal symptoms were more common after RALP.
Conclusions: There is a substantial risk for hospital readmission after prostate-cancer surgery regardless of technique; though major complications are rare. Regardless of surgical technique, attention should be focused on specific types of complications.
Source of Funding: The study was supported by research grants from the Swedish Cancer Foundation, Sahlgrenska University Hospital, Swedish Research Council, Mrs Mary von Sydow Foundation, Anna and Edvin Berger foundation, and EUSP fellowship grant to Dr Stavros I. Tyritzis.