1. Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy.
- Author
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Secin FP, Jiborn T, Bjartell AS, Fournier G, Salomon L, Abbou CC, Haber GP, Gill IS, Crocitto LE, Nelson RA, Cansino Alcaide JR, Martínez-Piñeiro L, Cohen MS, Tuerk I, Schulman C, Gianduzzo T, Eden C, Baumgartner R, Smith JA, Entezari K, van Velthoven R, Janetschek G, Serio AM, Vickers AJ, Touijer K, and Guillonneau B
- Subjects
- Aged, Europe epidemiology, Follow-Up Studies, Humans, Incidence, Laparoscopy methods, Male, Middle Aged, Phlebography, Postoperative Complications, Prognosis, Prostatic Neoplasms diagnosis, Pulmonary Embolism diagnosis, Pulmonary Embolism epidemiology, Retrospective Studies, Risk Factors, Tomography, X-Ray Computed, Ultrasonography, Doppler, United States epidemiology, Venous Thrombosis diagnosis, Venous Thrombosis epidemiology, Laparoscopy adverse effects, Prostatectomy methods, Prostatic Neoplasms surgery, Pulmonary Embolism etiology, Robotics methods, Venous Thrombosis etiology
- Abstract
Objectives: The true incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing laparoscopic radical prostatectomy is unknown. Our aim was to determine the incidence of symptomatic DVT and PE and the risk factors for these complications., Methods: Fourteen surgeons from 13 referral institutions from both Europe and the United States provided retrospective data for all 5951 patients treated with laparoscopic radical prostatectomy (LRP), with or without robotic assistance, since the start of their institution's experience. Symptomatic DVT and PE within 90 d of surgery were regarded as venous thromboembolism (VTE). DVT was diagnosed mostly by Doppler ultrasound or contrast venography and PE by lung ventilation/perfusion scan or chest computed tomography or both. Statistical analysis included evaluation of incidence of symptomatic DVT and PE and risk factors as determined by exact methods and logistic regression., Results: Of 5951 patients in the study, 31 developed symptomatic VTE (0.5%; 95% confidence interval [CI], 0.4%, 0.7%). Among patients with an event, 22 (71%) had DVT only, 4 had PE without identified DVT, and 5 had both. Two patients died of PE. Prior DVT (odds ratio [OR]=13.5; 95%CI, 1.4, 61.3), current tobacco smoking (OR=2.8; 95%CI, 1.0, 7.3), larger prostate volume (OR=1.18; 95%CI, 1.09, 1.28), patient re-exploration (OR=20.6; 95%CI, 6.6, 54.0), longer operative time (OR=1.05; 95%CI, 1.02, 1.09), and longer hospital stay (OR=1.05; 95%CI, 1.01, 1.09) were associated with VTE in univariate analysis. Neoadjuvant therapy, body mass index, surgical experience, surgical approach, pathologic stage, perioperative transfusion, and heparin administration were not significant predictors., Conclusions: The incidence of symptomatic VTE after LRP is low. These data do not support the administration of prophylactic heparin to all patients undergoing LRP, especially those without risk factors for VTE.
- Published
- 2008
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