The impact of extended pelvic lymph node dissection on the risk of hospital readmission within 180 days after robot assisted radical prostatectomy

• Published in: World journal of urology Vol. 38; no. 11; pp. 2799 - 2809
• Main Authors: Sebben, Marco, Tafuri, Alessandro, Shakir, Aliasger, Pirozzi, Marco, Processali, Tania, Rizzetto, Riccardo, Amigoni, Nelia, Tiso, Leone, De Michele, Mario, Panunzio, Andrea, Cerrato, Clara, Brunelli, Matteo, Migliorini, Filippo, Novella, Giovanni, De Marco, Vincenzo, Siracusano, Salvatore, Artibani, Walter, Porcaro, Antonio Benito
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2020; Springer Nature B.V
• Subjects: Cancer surgery; Lymph nodes; Lymphatic system; Medicine; Medicine & Public Health; Nephrology; Oncology; Original Article; Patients; Prostate cancer; Prostatectomy; Robotic surgery; Urological surgery; Urology; Robotic surgery; Radical prostatectomy; Complications; Prostate cancer; Hospital readmission
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-020-03094-2

Objective
To evaluate the factors associated with the risk of hospital readmission after robot assisted radical prostatectomy (RARP) with or without extended pelvic lymph node dissection (ePLND) for prostate cancer (PCA) over a long term.
Materials and methods
The risk of readmission was evaluated by clinical, pathological, and perioperative factors. Skilled and experienced surgeons performed the procedures. Patients were followed for complications and hospital readmission for a period of six months. The logistic regression model and Cox’s proportional hazards assessed the association of factors with the risk of readmission.
Results
From January 2013 to December 2018, 890 patients underwent RARP; ePLND was performed in 495 of these patients. Hospital readmission was detected in 25 cases (2.8%); moreover, it was more frequent when RARP was performed with ePLND (4.4% of cases) than without (0.8% of patients). On the final multivariate model, ePLND was the only independent factor that was positively associated with the risk of hospital readmission (hazard ratio, HR = 5935; 95%CI 1777–19,831;
p
 = 0.004).
Conclusions
Over the long term after RARP for PCA, the risk of hospital readmission is associated with ePLND. In patients who underwent RARP and ePLND, 4.4% of them had a readmission, compared to RARP alone, in which only 0.8% of cases had a readmission. When ePLND is planned for staging pelvic lymph nodes, patients should be informed of the increased risk of hospital readmission.