Risk of Small Bowel Obstruction After Robot-Assisted vs Open Radical Prostatectomy.
Whereas open radical prostatectomy is performed extraperitoneally, minimally invasive radical prostatectomy is typically performed within the peritoneal cavity. Our objective was to determine whether minimally invasive radical prostatectomy is associated with an increased risk of small bowel obstruction compared with open radical prostatectomy.



In the U.S. Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified 14,147 men found to have prostate cancer from 2000 to 2008 treated by open (n = 10,954) or minimally invasive (n = 3193) radical prostatectomy. Multivariable Cox proportional hazard models were used to examine the impact of surgical approach on the diagnosis of small bowel obstruction, as well as the need for lysis of adhesions and exploratory laparotomy.



During a median follow-up of 45 and 76 months, respectively, the cumulative incidence of small bowel obstruction was 3.7% for minimally invasive and 5.3% for open radical prostatectomy (p = 0.0005). Lysis of adhesions occurred in 1.1% of minimally invasive and 2.0% of open prostatectomy patients (p = 0.0003). On multivariable analysis, there was no significant difference between minimally invasive and open prostatectomy with respect to small bowel obstruction (HR 1.17, 95% CI 0.90, 1.52, p = 0.25) or lysis of adhesions (HR 0.87, 95% CI 0.50, 1.40, p = 0.57). Limitations of the study include the retrospective design and use of administrative claims data.



Relative to open radical prostatectomy, minimally invasive radical prostatectomy is not associated with an increased risk of postoperative small bowel obstruction and lysis of adhesions.
1 Department of Urology, New York University , New York, New York.|2 Department of Population Health, New York University , New York, New York.
Stacy
S
Loeb
3 Division of Urological Surgery, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.|4 Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.
Christian P
CP
Meyer
3 Division of Urological Surgery, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.|4 Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.
Anna
A
Krasnova
1 Department of Urology, New York University , New York, New York.|2 Department of Population Health, New York University , New York, New York.
Caitlin
C
Curnyn
3 Division of Urological Surgery, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.|4 Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.
Gally
G
Reznor
3 Division of Urological Surgery, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.|4 Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.
Adam S
AS
Kibel
1 Department of Urology, New York University , New York, New York.
Herbert
H
Lepor
3 Division of Urological Surgery, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.|4 Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.
Quoc-Dien
QD
Trinh
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000503:physiopathology*; D007421:Intestine, Small / Q000503:physiopathology*; D007813:Laparotomy; D008297:Male; D006278:Medicare; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000209:etiology*; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D012306:Risk; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D018426:SEER Program; D014481:United States
complications; open prostatectomy; prostate cancer; robot-assisted radical prostatectomy; small bowel obstruction