Platinum Priority – Prostate CancerEditorial by Markus Graefen on pp. 387–389 of this issueComprehensive Standardized Report of Complications of Retropubic and Laparoscopic Radical Prostatectomy☆
Introduction
With the introduction of laparoscopic radical prostatectomy (LP) and robot-assisted LP (RARP), there have been a number of publications comparing these more recent techniques to open radical retropubic prostatectomy (RP) [1], [2], [3], [4], [5], [6]. Differences in patterns of practice make comparison of complications across different approaches difficult and even more challenging across different institutions. To facilitate comparison of complication rates, consistency and clarity in reporting is necessary, as some authors have advocated [7].
The more widespread use of grading schemes [8] in reporting complications has facilitated standardization to some degree. Martin et al [7] have identified 10 critical elements of accurate and comprehensive reports of surgical complications (Appendix A). Although capture of all complications may be impossible in a retrospective study due to poor documentation, even in prospective studies [1], some complication categories may not be reported. A review of the studies evaluating complication rates in the urologic oncology literature reported that only 2% met 9 or 10 of Martin et al's criteria and 21% met 7 or 8 criteria. The most commonly underreported criteria were complication definitions, complication severity/grade, outpatient data, comorbidities, and duration of the reporting period [9].
We sought to apply the standards set forth by Martin et al [7] in performing a comprehensive report on the complications of radical prostatectomy at our institution in an effort to encourage the use of standardized reporting in the literature and, thus, to facilitate comparison across institutions and surgical approaches and to aid in patient counseling.
Section snippets
Patients and methods
Between January 1999 and June 2007, 4592 consecutive patients underwent radical prostatectomy (RP or LP) for adenocarcinoma of the prostate at our institution. Patients undergoing LP received low-molecular-weight heparin starting before surgery and continued daily until discharge; patients undergoing RP did not routinely receive low-molecular-weight heparin but had sequential compression boots.
Data were collected from a prospective prostatectomy database together with a prospective
Patient population
Table 1 summarizes the clinical characteristics of the 4592 patients by prostatectomy approach with open RP performed in 3458 men (75.3%) and LP (including 97 RARP cases) in 1134 men (24.7%). Prior treatment in 246 patients consisted of prior chemotherapy (n = 45) or hormonal therapy (n = 224). Median patient age was 59.5 yr (interquartile range [IQR]: 54.7–64.2). The patient population was generally healthy, with an ASA score ≤2 in 4007 men (87.3%) and a modified Charlson score <2 in 2076 men
Discussion
With the introduction of any surgical technique, there is a need to evaluate the complication rate in a sound and consistent manner to allow comparison across institutions and across different approaches. In a review of 119 articles in the surgical literature, Martin et al [7] developed 10 criteria to judge the quality of complication reporting. Of the 10 criteria, no articles met all criteria, 2% met 9 criteria, and 38% met 7 or 8 criteria; 52% met ≤4 criteria. In the present study, we have
Conclusions
Using standardized criteria, medical and surgical complications were present in 8.8% and 18.7% of RP patients, respectively, and in 14.5% and 24.5% of LP patients, respectively. Although best examined prospectively, these findings may be useful to counsel patients, to identify potentially modifiable risk factors, and to facilitate comparisons between institutions and techniques. With further standardized reporting from multiple institutions, a risk stratification scheme may be able to be
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