Hospital readmissions after limited vs. extended lymph node dissection during open and robot-assisted radical prostatectomy

Hospital readmissions after limited vs. extended lymph node dissection during open and robot-assisted radical prostatectomy

•The risk for hospital readmission was similar, but considerable when performing limited or extended lymph node dissection (LND) during a radical prostatectomy.•Robot-assisted technique for performing extended LND may decrease the risk for readmission due to severe complications compared to open sur...

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Bibliographic Details
Published in:Urologic oncology Vol. 38; no. 1; pp. 5.e1 - 5.e8
Main Authors: Tyritzis, Stavros I., Wilderäng, Ulrica, Lantz, Αnna Wallerstedt, Steineck, Gunnar, Hugosson, Jonas, Bjartell, Anders, Stranne, Johan, Haglind, Eva, Wiklund, Nils Peter
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-01-2020
Subjects:
Adult
Aged
Cancer and Oncology
Cancer och onkologi
Clinical Medicine
Complications
Extended
Humans
Kirurgi
Klinisk medicin
Limited
Lymph node dissection
Lymph Node Excision - methods
Male
Medical and Health Sciences
Medicin och hälsovetenskap
Middle Aged
Open
Patient Readmission - statistics & numerical data
Prospective Studies
Prostatectomy - methods
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
Radical prostatectomy
Robot-assisted
Robotic Surgical Procedures - methods
Robotics - methods
Surgery
Urologi och njurmedicin
Urology and Nephrology
Radical prostatectomy
Lymph node dissection
Complications
Robot-assisted
Extended
Limited
Open
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Summary:•The risk for hospital readmission was similar, but considerable when performing limited or extended lymph node dissection (LND) during a radical prostatectomy.•Robot-assisted technique for performing extended LND may decrease the risk for readmission due to severe complications compared to open surgery.•Readmissions for surgical complications were the most often encountered for patients undergoing radical prostatectomy with LND. Differences exist concerning when and how to perform lymph node dissection (LND) during radical prostatectomy due to lack of high-grade evidence to its safety and efficacy. We aimed to compare readmission rates between limited and extended LND during open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP). We conducted a prospective trial of 3,706 eligible patients comparing ORP vs. RARP (LAPPRO). Six hundred and twenty-seven underwent concomitant LND. Data were retrieved for readmissions within 90 days from surgery from the Swedish Patient Registry. Causes for readmissions were classified according to the modified Clavien-Dindo classification system. We estimated risks for readmission stratified by type of LND and surgical approach. We recorded 107 readmissions in 90 patients. The overall readmission rate was 14% (90/627). In the open group, extended LND had a higher, but not statistically significant readmission rate of 18% compared to 11% after limited LND (95%CI 0.87–3.01). In the robot-assisted group, readmissions after extended LND did not differ from limited LND (15% vs. 18%, 95%CI 0.49–1.61). RARP with limited LND showed a higher risk for any (RR 1.98, 95%CI [1.02–3.81]) as well as Clavien-Dindo grade 1 to 2 readmissions (RR 2.49, 95%CI [1.10–5.63]) compared to open approach with limited LND. Robot-assisted extended LND reduced the risk for Clavien-Dindo grade 3 to 5 complications leading to readmissions compared to the open approach by 59% (RR 0.41, 95%CI [0.19-0.87]). The risk for hospital readmission was similar when performing limited or extended LND during a radical prostatectomy. Robot-assisted technique for performing extended LND may decrease the risk for severe complications.
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ISSN:1078-1439
1873-2496
1873-2496
DOI:10.1016/j.urolonc.2019.07.015