Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy.
BACKGROUND
The lack of standardized reporting of the complications of radical prostatectomy in the literature has made it difficult to compare incidences across institutions and across different surgical approaches.


OBJECTIVE
To define comprehensively the incidence, severity, and timing of onset of medical and surgical complications of open retropubic prostatectomy (RP) and laparoscopic radical prostatectomy (LP) using a standardized reporting methodology to facilitate comparison.


METHODS
Between January 1999 and June 2007, 4592 consecutive patients underwent RP or LP without prior radiation or hormonal therapy. Median follow-up was 36.9 mo (interquartile range: 20.3-60.6).


METHODS
Open or laparoscopic radical prostatectomy.


METHODS
All medical and surgical complications of radical prostatectomy were captured and graded according to the modified Clavien classification and classified by timing of onset.


CONCLUSIONS
There were 612 medical complications in 467 patients (10.2%) and 1426 surgical complications in 925 patients (20.1%). The overall incidences of early minor and major medical and surgical complications for RP were 8.5% and 1.5% for medical and 11.4% and 4.9% for surgical complications, respectively. The overall incidences of early minor and major medical and surgical complications for LP were 14.2% and 2.3% for medical and 23.1% and 6.6% for surgical complications, respectively. On multivariate analysis, LP approach was associated with a higher incidence of any grade medical and surgical complications but a lower incidence of major surgical complications than RP. Six hundred fifty-two men (14.2%) visited the emergency department, and 240 men (5.2%) required readmission. The main limitation is the retrospective nature.


CONCLUSIONS
With standardized reporting, the incidence of some complications is higher than recognized in the literature. Although most complications are minor in severity, medical and surgical complications are observed in approximately 10% and 20% of patients, respectively. Accurate reporting of complications through a standardized methodology is essential for counseling patients regarding risk of complications, for identifying modifiable risk factors, and for facilitating comparison across institutions and approaches.
Rabbani
Farhang
F
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. rabbanif@mskcc.org
Yunis
Luis Herran
LH
Pinochet
Rodrigo
R
Nogueira
Lucas
L
Vora
Kinjal C
KC
Eastham
James A
JA
Guillonneau
Bertrand
B
Laudone
Vincent
V
Scardino
Peter T
PT
Touijer
Karim
K
D000230:Adenocarcinoma / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors