Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: Does concomitant pelvic lymphadenectomy matter?

Abstract

Abstract:The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized , low volume disease and the risk of venous thromboembolism is very low. Multiple guidelines exist for the prevention of venous thromboembolism in patients undergoing radical retropubic prostatectomy and pharmacological venous thromboembolism prophylaxis is recommended. Most urological surgeons in the USA however, do not routinely utilize pharmacological prophylaxis. A major concern arises when radical retropubic prostatectomy is performed with a concomitant pelvic lymphadenectomy. Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously.

Safety of fondaparinux for prevention of postoperative venous thromboembolism in urological malignancy: A prospective randomized clinical trial

“…16 Meanwhile, Benjamin et al suggested that lymphocele was an independent risk factor for VTE, and pharmacological thromboprophylaxis increased the rate of lymphocele formation. 25 Lymphocele was diagnosed in three patients who had undergone prostatectomy with concomitant pelvic lymphadenectomy in the present study. However, there were no VTE events in these cases.…”

Predictors of symptomatic lymphocele after radical prostatectomy and bilateral pelvic lymph node dissection

“…Perioperative administration of heparin to prevent deep venous thrombosis has been associated with lymphocele development. [14][15][16] However, a recent study by Naselli et al found no association between the use of heparin prophylaxis and development of lymphoceles. 3 In the present study, patients undergoing LRP routinely received LMWH, starting before surgery and continued daily until discharge, whereas patients undergoing ORP did not routinely receive LMWH, but had sequential compression boots unless there was a history of thromboembolism.…”

“…Perioperative administration of heparin to prevent deep venous thrombosis has been associated with lymphocele development 14–16 . However, a recent study by Naselli et al .…”

Thromboembolic Complications in 3,544 Patients Undergoing Radical Prostatectomy with or without Lymph Node Dissection

“…142 In the open surgery thromboembolic events could be due to the extra peritoneal approach. 143,144,145 Lymph-node dissection also leads to an increased risk of lymphocele formation, especially after open surgery. 146…”