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

Tyritzis, Stavros I. ; Wilderäng, Ulrica ; Lantz, Αnna Wallerstedt ; Steineck, Gunnar ; Hugosson, J. ; Bjartell, Anders LU ; Stranne, J. ; Haglind, Eva and Wiklund, Nils Peter (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.

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author
organization
publishing date
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
  • pmid:31445896
  • scopus:85070896837
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
2020-01-26 05:42:01
@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},
  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},
}