INTRODUCTION AND OBJECTIVES: Venous thromboembolic events (VTE) are the most common non-surgical complication after radical prostatectomy (RP), and represent the most common cause of death within 30 days of surgery.
While effective mechanical and chemoprophylaxis exist, the use of such prophylaxis may also be associated with increased complications. To identify VTE risk factors, and thereby facilitate targeted prophylaxis, we characterized clinicopathologic variables associated with VTE among patients undergoing RP.
METHODS: We reviewed 18,472 consecutive patients who underwent RP with pelvic lymphadenectomy (PLND) for prostate cancer at our institution from 1987 to 2010. After surgery, patients were followed for the development of postoperative complications. VTE within 30 days of surgery were recorded. Logistic regression models were used to analyze clinicopathological variables associated with VTE.
RESULTS: We identified symptomatic VTE in 271 (1.4%) patients. The diagnosis of VTE was not associated with preoperative body mass index, PSA, Gleason score, or cancer recurrence. VTE diagnosis, however, was significantly associated with non-O blood type (OR- 1.98, p=0.004), an increasing number of lymph nodes removed (OR- 1.05, p=0.035) and blood transfusion (OR - 1.30, p=0.02). Patients with VTE were significantly more likely to die within 30 days of surgery (3.0 vs 0%, p< 0.001).
CONCLUSIONS: Blood type, extent of pelvic lymphadenectomy and blood transfusion are significant risk factors for symptomatic VTE following RP+PLND. These data should be utilized for patient counseling, particularly with regard to obviating lymphadenectomy in low-risk patients, and for individualizing VTE prophylaxis in higher-risk patients.
Written by:
Tollefson MK, Karnes RJ, Rangel L, Carlson R, Boorjian SA. Are you the author?
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN 55905.
Reference: J Urol. 2013 Oct 17. pii: S0022-5347(13)05675-9.
doi: 10.1016/j.juro.2013.10.062
PubMed Abstract
PMID: 24140843
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