The impact of extended pelvic lymph node dissection on the risk of hospital readmission within 180 days after robot assisted radical prostatectomy

Sebben, Marco; Tafuri, Alessandro; Shakir, Aliasger; Pirozzi, Marco; Processali, Tania; Rizzetto, Riccardo; Amigoni, Nelia; Tiso, Leone; Michele, Mario De; Panunzio, Andrea; Cerrato, Clara; Brunelli, Matteo; Migliorini, Filippo; Novella, Giovanni; Marco, Vincenzo De; Siracusano, Salvatore; Artibani, Walter; Porcaro, Antonio Benito

doi:10.1007/s00345-020-03094-2

Cited by 17 publications

(17 citation statements)

References 40 publications

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“…Length of hospital stay (LOHS) was measured in days and started from the day of operation. Hospital readmission events were also evaluated and complications were reclassified according the Clavien-Dindo system [1,2,12].…”

Section: Methodsmentioning

confidence: 99%

American Society of Anesthesiologists’ (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients

Porcaro

Rizzetto

Amigoni

et al. 2022

Indian J Surg Oncol

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Objective To test the hypothesis of associations of preoperative physical status system with major postoperative complications at hospital discharge in prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Materials and Methods In a period ranging from January 2013 to October 2020, 1143 patients were evaluated. The physical status was assessed by the American Society of Anesthesiologists’ (ASA) system, which was computed trained anesthesiologists. The Clavien-Dindo system was used to classify postoperative complications, which were coded as major if greater than 1. Results ASA physical status system included class I in 102 patients (8.9%), class II in 934 subjects (81.7%), and class III in 107 cases (9.4%). Clavien-Dindo complications were distributed as follows: grade 1: 141 cases (12.3%), grade 2: 108 patients (9.4%), grade 3a: 5 subjects (0.4%), grade 3b: 9 patients (0.8%), and grade 4a: 3 cases (0.3%). Overall, major complications were detected in 125 cases (10.9%). On multivariate analysis, major Clavien-Dindo complications were predicted by ASA score grade II (adjusted odds ratio, OR = 2.538; 95%CI 1.007–6.397; p = 0.048) and grade III (adjusted OR 3.468; 95%CI 1.215–9.896; p = 0.020) independently by pelvic lymph node dissection (PLND) and/or blood lost. Conclusion In RARP surgery, the risk of major postoperative Clavien-Dindo complications increased as the physical status system deteriorated independently by performing or not a PLND and/or large intraoperative blood lost. The ASA score system was an effective predictor of major Clavien-Dindo complications, which delayed LOHS in RARP surgery. Confirmatory studies are required.

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Section: Methodsmentioning

confidence: 99%

American Society of Anesthesiologists’ (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients

Porcaro

Rizzetto

Amigoni

et al. 2022

Indian J Surg Oncol

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“…ePLND was performed according to guidelines [ 1 , 2 ]. Dissected lymph nodes were submitted in separate packages according to a standard anatomical template including external iliac, internal iliac plus obturator, Marcille’s common iliac, and Cloquet’s nodal stations, bilaterally [ 12 ]. Prostates were weighted and tumors were graded by the dedicated pathologist according to the International Society of Urologic Pathology (ISUP) system [ 1 , 2 ].…”

Section: Methodsmentioning

confidence: 99%

“…Perioperative outcomes were evaluated for operating time, estimated intraoperative blood loss, nerve-sparing surgery, high and low volume surgeons, length of hospital stay (LOHS), and hospital readmission after discharge. Postoperative complications were coded according to the Clavien–Dindo system [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

Advanced age portends poorer prognosis after radical prostatectomy: a single center experience

et al. 2022

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Introduction and objective Although advanced age doesn’t seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center. Materials and methods 1143 patients with clinically localized PCa underwent RARP from January 2013 to October 2020. Analysis was performed on 901 patients with available follow-up. Patients ≥ 70 years old were considered elderly. Unfavorable pathology included ISUP grade group > 2, seminal vesicle, and pelvic lymph node invasion. Disease progression was defined as biochemical and/or local recurrence and/or distant metastases. Results 243 cases (27%) were classified as elderly patients (median age 72 years). Median (IQR) follow-up was 40.4 (38.7–42.2) months. Disease progression occurred in 159 cases (17.6%). Elderly patients were more likely to belong to EAU high-risk class, have unfavorable pathology, and experience disease progression after surgery (HR = 5.300; 95% CI 1.844–15.237; p = 0.002) compared to the younger patients. Conclusions Elderly patients eligible for RARP are more likely to belong to the EAU high-risk category and to have unfavorable pathology that are independent predictors of disease progression. Advanced age adversely impacts on oncological outcomes when evaluated inside these unfavorable categories. Accordingly, elderly patients belonging to the EAU high-risk should be counseled about the increased risk of disease progression after surgery.

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“…Specifically, the decision was based on clinical factors (pre-biopsy PSA > 7 ng/mL, and percentage of BPC > 20%) indicating an increased risk of tumor upgrading and lymph node invasion (LNI) in the surgical specimen [ 11 , 12 ]. Dissected lymph nodes were submitted in separate packages according to a standard anatomical template including external iliac, internal iliac and obturator, Marcille’s common iliac, and Cloquet’s nodal stations, bilaterally [ 13 , 14 , 15 ]. Specimens including prostate and eventually dissected lymph nodes were placed into formalin and evaluated by the dedicated pathologist.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Impact and Clinical Implications of Unfavorable Upgrading in Low-Risk Prostate Cancer after Robot-Assisted Radical Prostatectomy: Results of a Single Tertiary Referral Center

Porcaro

Panunzio

Bianchi

et al. 2022

Cancers

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Objective: to evaluate predictors and the prognostic impact of favorable vs. unfavorable tumor upgrading among low-risk prostate cancer (LR PCa) patients treated with robot-assisted radical prostatectomy (RARP). Methods: From January 2013 to October 2020, LR PCa patients treated with RARP at our institution were identified. Unfavorable tumor upgrading was defined as the presence of an International Society of Urological Pathology (ISUP) grade group at final pathology > 2. Disease relapse was coded as biochemical recurrence and/or local recurrence and/or presence of distant metastases. Regression analyses tested the association between clinical and pathological features and the risk of unfavorable tumor upgrading and disease relapse. Results: Of the 237 total LR PCa patients, 60 (25.3%) harbored unfavorable tumor upgrading. Disease relapse occurred in 20 (8.4%) patients. Unfavorable upgrading represented an independent predictor of disease relapse, even after adjustment for other clinical and pathological variables. Conversely, favorable tumor upgrading did not show any statistically significant association with PCa relapse. Unfavorable tumor upgrading was associated with tumors being larger (OR: 1.03; p = 0.031), tumors extending beyond the gland (OR: 8.54, p < 0.001), age (OR: 1.07, p = 0.009), and PSA density (PSAD) ≥ 0.15 ng/mL/cc (OR: 1.07, p = 0.009). Conclusions: LR PCa patients with unfavorable upgrading at final pathology were more likely to be older, to have PSAD ≥ 0.15 ng/mL/cc, and to experience disease relapse. Unfavorable tumor upgrading is an issue to consider when counseling these patients to avoid delayed treatments, which may impair cancer-specific survival.

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The impact of extended pelvic lymph node dissection on the risk of hospital readmission within 180 days after robot assisted radical prostatectomy

Cited by 17 publications

References 40 publications

American Society of Anesthesiologists’ (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients

American Society of Anesthesiologists’ (ASA) Physical Status System and Risk of Major Clavien-Dindo Complications After Robot-Assisted Radical Prostatectomy at Hospital Discharge: Analysis of 1143 Consecutive Prostate Cancer Patients

Advanced age portends poorer prognosis after radical prostatectomy: a single center experience

Prognostic Impact and Clinical Implications of Unfavorable Upgrading in Low-Risk Prostate Cancer after Robot-Assisted Radical Prostatectomy: Results of a Single Tertiary Referral Center

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