Hospital readmissions after limited vs. extended lymph node dissection during open and robot-assisted radical prostatectomy
(2020) In Urologic Oncology: Seminars and Original Investigations 38(1). p.1-8- Abstract
Purpose: 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). Materials and methods: 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... (More)
Purpose: 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). Materials and methods: 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. Results: 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]). Conclusions: 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.
(Less)
- author
- Tyritzis, Stavros I. ; Wilderäng, Ulrica ; Lantz, Αnna Wallerstedt ; Steineck, Gunnar ; Hugosson, J. ; Bjartell, Anders LU ; Stranne, J. ; Haglind, Eva and Wiklund, Nils Peter
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Complications, Extended, Limited, Lymph node dissection, Open, Radical prostatectomy, Robot-assisted
- in
- Urologic Oncology: Seminars and Original Investigations
- volume
- 38
- issue
- 1
- pages
- 1 - 8
- publisher
- Elsevier
- external identifiers
-
- scopus:85070896837
- pmid:31445896
- ISSN
- 1078-1439
- DOI
- 10.1016/j.urolonc.2019.07.015
- language
- English
- LU publication?
- yes
- id
- 1f063f15-2935-423e-a9d7-95181c7e77ec
- date added to LUP
- 2019-09-12 13:46:25
- date last changed
- 2024-04-02 17:24:23
@article{1f063f15-2935-423e-a9d7-95181c7e77ec,
abstract = {{<p>Purpose: 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). Materials and methods: 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. Results: 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]). Conclusions: 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.</p>}},
author = {{Tyritzis, Stavros I. and Wilderäng, Ulrica and Lantz, Αnna Wallerstedt and Steineck, Gunnar and Hugosson, J. and Bjartell, Anders and Stranne, J. and Haglind, Eva and Wiklund, Nils Peter}},
issn = {{1078-1439}},
keywords = {{Complications; Extended; Limited; Lymph node dissection; Open; Radical prostatectomy; Robot-assisted}},
language = {{eng}},
number = {{1}},
pages = {{1--8}},
publisher = {{Elsevier}},
series = {{Urologic Oncology: Seminars and Original Investigations}},
title = {{Hospital readmissions after limited vs. extended lymph node dissection during open and robot-assisted radical prostatectomy}},
url = {{http://dx.doi.org/10.1016/j.urolonc.2019.07.015}},
doi = {{10.1016/j.urolonc.2019.07.015}},
volume = {{38}},
year = {{2020}},
}