title: Thromboembolic complications in 3,544 patients undergoing radical prostatectomy with or without lymph node dissection.
abstract: OBJECTIVE
  Lymph node dissection in patients with prostate cancer may increase complications. An association of lymph node dissection with thromboembolic events was suggested. We compared the incidence and investigated predictors of deep venous thrombosis and pulmonary embolism among other complications in patients who did or did not undergo lymph node dissection during open and robot-assisted laparoscopic radical prostatectomy.
  
  
  METHODS
  Included in study were 3,544 patients between 2008 and 2011. The cohort was derived from LAPPRO, a multicenter, prospective, controlled trial. Data on adverse events were extracted from patient completed questionnaires. Our primary study outcome was the prevalence of deep venous thrombosis and/or pulmonary embolism. Secondary outcomes were other types of 90-day adverse events and causes of hospital readmission.
  
  
  RESULTS
  Lymph node dissection was performed in 547 patients (15.4%). It was associated with eightfold and sixfold greater risk of deep venous thrombosis and pulmonary embolism events compared to that in patients without lymph node dissection (RR 7.80, 95% CI 3.51-17.32 and 6.29, 95% CI 2.11-18.73, respectively). Factors predictive of thromboembolic events included a history of thrombosis, pT4 stage and Gleason score 8 or greater. Open radical prostatectomy and lymph node dissection carried a higher risk of deep venous thrombosis and/or pulmonary embolism than robot-assisted laparoscopic radical prostatectomy (RR 12.67, 95% CI 5.05-31.77 vs 7.52, 95% CI 2.84-19.88). In patients without lymph node dissection open radical prostatectomy increased the thromboembolic risk 3.8-fold (95% CI 1.42-9.99) compared to robot-assisted laparoscopic radical prostatectomy. Lymph node dissection induced more wound, respiratory, cardiovascular and neuromusculoskeletal events. It also caused more readmissions than no lymph node dissection (14.6% vs 6.3%).
  
  
  CONCLUSIONS
  Among other adverse events we found that lymph node dissection during radical prostatectomy increased the incidence of deep venous thrombosis and pulmonary embolism. Open surgery increased the risks more than robot-assisted surgery. This was most prominent in patients who were not treated with lymph node dissection.
authors.affiliation: Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece. Electronic address: stavros.tyritzis.2@ki.se.
authors.forename: Stavros I
authors.initials: SI
authors.lastname: Tyritzis
authors.affiliation: Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Wallerstedt
authors.affiliation: Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.affiliation: Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.affiliation: Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.affiliation: Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Oncology, Lund University, Lund, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Bjartell
authors.affiliation: Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.affiliation: Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Faculty of Nursing, University of Iceland, Reykjavik, Iceland.
authors.forename: Thordis
authors.initials: T
authors.lastname: Thorsteinsdottir
authors.affiliation: Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.affiliation: Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Stranne
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Haglind
authors.affiliation: Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nils Peter
authors.initials: NP
authors.lastname: Wiklund
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013923:Thromboembolism / Q000209:etiology*
keywords: lymph node excision; prostate; prostatectomy; pulmonary embolism; venous thrombosis