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Multi-institutional Study of Symptomatic Deep Venous Thrombosis and Pulmonary Embolism in Prostate Cancer Patients Undergoing Laparoscopic or Robot-Assisted Laparoscopic Radical Prostatectomy

Secin, Fernando P; Jiborn, Thomas LU ; Bjartell, Anders LU ; Fournier, Georges; Salomon, Laurent; Abbou, Clement Claude; Haber, George P; Gill, Inderbir S; Crocitto, Laura E and Nelson, Rebecca A, et al. (2008) In European Urology 53(1). p.134-145
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... (More)
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. (Less)
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publication status
published
subject
keywords
Prostate cancer, Laparoscopy, Venous thromboembolism, Complication, Radical prostatectomy
in
European Urology
volume
53
issue
1
pages
134 - 145
publisher
Elsevier
external identifiers
  • pmid:17597288
  • wos:000251956600027
  • scopus:36448963430
ISSN
1873-7560
DOI
10.1016/j.eururo.2007.05.028
language
English
LU publication?
yes
id
36e0aa41-2722-4f39-8fa5-430d9ab7dcc1 (old id 1144403)
date added to LUP
2008-08-15 09:48:55
date last changed
2017-08-06 03:55:18
@article{36e0aa41-2722-4f39-8fa5-430d9ab7dcc1,
  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.},
  author       = {Secin, Fernando P and Jiborn, Thomas and Bjartell, Anders and Fournier, Georges and Salomon, Laurent and Abbou, Clement Claude and Haber, George P and Gill, Inderbir S and Crocitto, Laura E and Nelson, Rebecca A and Cansino Alcaide, Jose R and Martinez-Pineiro, Luis and Cohen, Michael S and Tuerk, Ingolf and Schulman, Claude and Gianduzzo, Troy and Eden, Christopher and Baumgartner, Roxelyn and Smith, Joseph A and Entezari, Kim and van Velthoven, Roland and Janetschek, Gunter and Serio, Angel M and Vickers, Andrew J and Touijera, Karim and Guillonneau, Bertrand},
  issn         = {1873-7560},
  keyword      = {Prostate cancer,Laparoscopy,Venous thromboembolism,Complication,Radical prostatectomy},
  language     = {eng},
  number       = {1},
  pages        = {134--145},
  publisher    = {Elsevier},
  series       = {European Urology},
  title        = {Multi-institutional Study of Symptomatic Deep Venous Thrombosis and Pulmonary Embolism in Prostate Cancer Patients Undergoing Laparoscopic or Robot-Assisted Laparoscopic Radical Prostatectomy},
  url          = {http://dx.doi.org/10.1016/j.eururo.2007.05.028},
  volume       = {53},
  year         = {2008},
}