Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy.
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.
Secin
Fernando P
FP
Memorial Sloan-Kettering Cancer Center, Department of Urology, New York, NY 10021, USA.
Jiborn
Thomas
T
Bjartell
Anders S
AS
Fournier
Georges
G
Salomon
Laurent
L
Abbou
Clément Claude
CC
Haber
George P
GP
Gill
Inderbir S
IS
Crocitto
Laura E
LE
Nelson
Rebecca A
RA
Cansino Alcaide
José R
JR
Martínez-Piñeiro
Luis
L
Cohen
Michael S
MS
Tuerk
Ingolf
I
Schulman
Claude
C
Gianduzzo
Troy
T
Eden
Christopher
C
Baumgartner
Roxelyn
R
Smith
Joseph A
JA
Entezari
Kim
K
van Velthoven
Roland
R
Janetschek
Gunter
G
Serio
Angel M
AM
Vickers
Andrew J
AJ
Touijer
Karim
K
Guillonneau
Bertrand
B
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*