Standardized report for early complications of radical prostatectomy.
BACKGROUND
Radical prostatectomy (RP) is one of the curative treatment options for patients with prostate cancer to achieve long-term survival, but it is accompanied by potential complications. The Martin criteria used as a format for reporting complications has become standard in recent years. However, it has not been applied in RP in Asian countries. In the present study, we investigated the early complications of RP developing within 90 days in our institute according to the Martin criteria.


METHODS
Between January 2003 and November 2011, patients with organ-confined adenocarcinoma of the prostate who received RP in our institute were retrospectively reviewed. The operation was done as open RP, or minimally invasive RP, including laparoscopic RP and robot-assisted laparoscopic RP (RaLP). The preoperative, operative, postoperative, and pathological parameters were recorded for analysis. Definitions of complications were adopted from previous reports. Surgical and medical complications developed within 90 days postoperatively were identified respectively; severity of each complication was classified according to Clavien-Dindo classification. Clavien-Dindo classification grade III or higher complications were viewed as major complications.


RESULTS
A total of 359 patients were included; 280 (78%) underwent open RP, 45 (12.5%) received laparoscopic RP, and 34 (9.5%) had RaLP. The overall complication rate was 40.1%, and the major complication rate was 13.1%. There was no surgical mortality. Diarrhea requiring conservative treatment (13.6%), minor urine leakage (9.5%), and gout attack (4.2%) were the leading complications. Minimally invasive RP had higher rates of lymph leakage (p = 0.015) and upper-extremity neuropathy (p = 0.048). Body mass index >25 kg/m(2) and use of neoadjuvant hormone therapy were predictors for overall and major complications, whereas diabetes mellitus also predicted the development of major complications. Besides lower case volume and learning curve for RaLP, patients' higher age at surgery and higher risk for disease progression compared to the Western series may be responsible for the higher complication rates.


CONCLUSIONS
The early complication rates of RP in our patients were slightly high compared to the Western series. By standardized report, being overweight, diabetes mellitus, and use of neoadjuvant hormone therapy were identified as predictors of early complications in our series.
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Wei-Ming
WM
Cheng
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: tplin63@vghtpe.gov.tw.
Tzu-Ping
TP
Lin
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Chih-Chieh
CC
Lin
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Eric Yi-Hsiu
EY
Huang
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Hsiao-Jen
HJ
Chung
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Junne-Yih
JY
Kuo
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
William J S
WJ
Huang
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Yen-Hwa
YH
Chang
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Alex T L
AT
Lin
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Kuang-Kuo
KK
Chen
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*
complications; prostatectomy; prostatic neoplasms