title: Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  The true incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing laparoscopic radical prostatectomy is unknown. Our aim was to determine the incidence of symptomatic DVT and PE and the risk factors for these complications.
  
  
  METHODS
  Fourteen surgeons from 13 referral institutions from both Europe and the United States provided retrospective data for all 5951 patients treated with laparoscopic radical prostatectomy (LRP), with or without robotic assistance, since the start of their institution's experience. Symptomatic DVT and PE within 90 d of surgery were regarded as venous thromboembolism (VTE). DVT was diagnosed mostly by Doppler ultrasound or contrast venography and PE by lung ventilation/perfusion scan or chest computed tomography or both. Statistical analysis included evaluation of incidence of symptomatic DVT and PE and risk factors as determined by exact methods and logistic regression.
  
  
  RESULTS
  Of 5951 patients in the study, 31 developed symptomatic VTE (0.5%; 95% confidence interval [CI], 0.4%, 0.7%). Among patients with an event, 22 (71%) had DVT only, 4 had PE without identified DVT, and 5 had both. Two patients died of PE. Prior DVT (odds ratio [OR]=13.5; 95%CI, 1.4, 61.3), current tobacco smoking (OR=2.8; 95%CI, 1.0, 7.3), larger prostate volume (OR=1.18; 95%CI, 1.09, 1.28), patient re-exploration (OR=20.6; 95%CI, 6.6, 54.0), longer operative time (OR=1.05; 95%CI, 1.02, 1.09), and longer hospital stay (OR=1.05; 95%CI, 1.01, 1.09) were associated with VTE in univariate analysis. Neoadjuvant therapy, body mass index, surgical experience, surgical approach, pathologic stage, perioperative transfusion, and heparin administration were not significant predictors.
  
  
  CONCLUSIONS
  The incidence of symptomatic VTE after LRP is low. These data do not support the administration of prophylactic heparin to all patients undergoing LRP, especially those without risk factors for VTE.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, Department of Urology, New York, NY 10021, USA.
authors.forename: Fernando P
authors.initials: FP
authors.lastname: Secin
authors.forename: Thomas
authors.initials: T
authors.lastname: Jiborn
authors.forename: Anders S
authors.initials: AS
authors.lastname: Bjartell
authors.forename: Georges
authors.initials: G
authors.lastname: Fournier
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Clément Claude
authors.initials: CC
authors.lastname: Abbou
authors.forename: George P
authors.initials: GP
authors.lastname: Haber
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Laura E
authors.initials: LE
authors.lastname: Crocitto
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Nelson
authors.forename: José R
authors.initials: JR
authors.lastname: Cansino Alcaide
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Piñeiro
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Ingolf
authors.initials: I
authors.lastname: Tuerk
authors.forename: Claude
authors.initials: C
authors.lastname: Schulman
authors.forename: Troy
authors.initials: T
authors.lastname: Gianduzzo
authors.forename: Christopher
authors.initials: C
authors.lastname: Eden
authors.forename: Roxelyn
authors.initials: R
authors.lastname: Baumgartner
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Kim
authors.initials: K
authors.lastname: Entezari
authors.forename: Roland
authors.initials: R
authors.lastname: van Velthoven
authors.forename: Gunter
authors.initials: G
authors.lastname: Janetschek
authors.forename: Angel M
authors.initials: AM
authors.lastname: Serio
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Vickers
authors.forename: Karim
authors.initials: K
authors.lastname: Touijer
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillonneau
mesh_terms: D000368:Aged; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011183:Postoperative Complications; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000379:methods*; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*