30-Day Postoperative Complication Risk Higher in Radical Prostatectomy With Pelvic Lymph Node Dissection

Patients with prostate cancer who underwent radical prostatectomy with pelvic lymph node dissection (PLND) are at an increased risk of 30-day postoperative complications than those who received the surgery without PLND, according to the findings of a retrospective cohort study.

Vatsala Mundra, a medical student at the University of Texas Southwestern Medical Center, Dallas, and colleagues conducted the study using the American College of Surgeons National Surgical Quality Improvement Program targeted prostatectomy database.

They identified 13,413 patients who had a prostatectomy between 2019-2022, of which 85% received PLND and 15% did not. To balance the groups, the researchers used propensity score matching to narrow the cohort to 4,142 patients with (n=2,071) and without PLND (n=2,071). Patients were matched for demographics, such as age, body mass index, race, prior medical history, and cancer staging.

“Multiple guidelines recommend PLND for staging purposes and there may also be a therapeutic benefit. However, PLND is not without complications and nomograms predicting risk of lymph node metastasis may be employed to optimize selection,” the researchers said.

To understand these risks, researchers analyzed the rates of real-world 30-day postoperative outcomes in patients. These included mortality, reoperation, cardiac events, and neurologic events. Secondary outcomes consisted of infectious and venous thromboembolic complications, unplanned intubation and ventilation, transfusion, readmission, and prolonged length of stay (LOS). In addition, rectal injury, ureteral obstruction, and lymphocele were evaluated as procedure-specific outcomes.

Study findings, which were presented during the 25^th Annual Meeting of the SUO, demonstrated no significant differences between the two cohorts regarding primary outcomes. Thirty-day mortality occurred in six patients and 33 had reoperation.

However, the PLND cohort showed a 2.5 times increased risk of deep vein thrombosis compared with the non-PLND cohort (0.97% vs 0.39%, respectively). Moreover, lymphocele or other lymphatic leaks were 4 times higher in the PLND cohort than in the non-PLND cohort (1.79% vs 0.43%, respectively).

Both cohorts experienced urinary leak or fistula (PLND 1.4% vs non-PLND 1.3%), ureter obstruction (PLND 0.29% vs non-PLND 0.20%), and rectal injury (PLND 0.38% vs non-PLND 0.30%). However, the researchers said there was no significant association between PLND and the risk of these three complications.

Furthermore, hospital readmission rates were higher in the PLND cohort (n=80) than in the non-PLND (n=58). Overall, 742 patients had a prolonged LOS in the hospital.

Reference

Mundra V, Xu S, Titus R, et al. Complications of robotic pelvic lymph node dissection for prostate cancer: an analysis of the national surgical quality improvement program targeted radical prostatectomy database. Poster #8. Presented at the 25th Annual Meeting of the Society of Urologic Oncology; December 4-6, 2024; Dallas, Texas.