Perioperative outcomes following radical prostatectomy for patients with disseminated cancer: An analysis of the National Surgical Quality Improvement Program database

Raj Satkunasivam, Christopher J.D. Wallis, James Byrne, Azik Hoffman, Douglas C. Cheung, Girish S. Kulkarni, Avery B. Nathens, Robert K. Nam


Introduction: We sought to determine whether patients undergoing radical prostatectomy (RP) in the context of disseminated cancer have higher 30-day complications.

Methods: We conducted a retrospective cohort study of the National Surgical Quality Improvement Program (NSQIP) database. Men undergoing RP (from January 1, 2005 to December 31, 2014) for prostate cancer were identified and stratified by presence (n=97) or absence (n=27 868) of disseminated cancer. The primary outcome was major complications (death, re-operation, cardiac or neurologic events) within 30 days of surgery. Secondary outcomes included pulmonary, infectious, venous thromboembolic, and bleeding complications; prolonged length of stay; and concomitant procedures (bowel-related, cystectomy, urinary diversion, and major ureteric reconstruction). Odds ratios (OR) for each complication were calculated using univariable logistic regression.

Results: We did not identify a difference in major complication rates (OR 2.26, 95% confidence interval [CI] 0.71‒7.16). Patients with disseminated cancer had increased risk of venous thromboembolic events (OR 3.30, 95% CI 1.04‒10.48) and transfusion (OR 2.45, 95% CI 1.18‒5.05), but similar odds of pulmonary and infectious complications and length of stay. Bowel procedures were rare, however, a significantly higher proportion of patients with disseminated cancer required bowel procedures (2.1% vs. 0.3%; p=0.03). Patients with disseminated cancer undergoing RP had greater comorbidities and higher predicted probability of morbidity and mortality. This study is limited by its retrospective design, lack of cancer-specific variables, and prostatectomyspecific complications.

Conclusions: RP in the context of disseminated cancer may be associated with increased perioperative complications. Caution should be exercised in embarking on this practice outside of clinical trials.

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