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Porcaro AB, Orlando R, Panunzio A, Tafuri A, Baielli A, Artoni F, Brancelli C, Roggero L, Costantino S, Franceschini A, Boldini M, Treccani LP, Montanaro F, Gallina S, Bianchi A, Serafin E, Mazzucato G, Ditonno F, Finocchiaro M, Veccia A, Rizzetto R, Brunelli M, De Marco V, Siracusano S, Cerruto MA, Bertolo R, Antonelli A. Preoperative Briganti Nomogram Score and Risk of Prostate Cancer Progression After Robotic Surgery Beyond EAU Risk Categories. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1763. [PMID: 39596948 PMCID: PMC11596480 DOI: 10.3390/medicina60111763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 10/03/2024] [Accepted: 10/25/2024] [Indexed: 11/29/2024]
Abstract
Background and Objectives: We sought to investigate whether the 2012 Briganti nomogram may represent a potential prognostic factor of prostate cancer (PCa) progression after surgical treatment beyond European Association of Urology (EAU) risk categories. Materials and Methods: From January 2013 to December 2021, data on PCa patients treated with robot-assisted radical prostatectomy at a single tertiary referral center were extracted. The 2012 version of the Briganti nomogram assessing the risk of pelvic lymph node invasion was used. Here, the nomogram score was evaluated both as a continuous and a categorical variable. The association between variables and disease progression after surgery was evaluated through Cox regression models. Results: Overall, 1047 patients were identified. According to the EAU classification system, 297 (28.4%) patients were low-risk, 527 (50.3%) intermediate-risk, and 223 (21.3%) high-risk. The median (interquartile range) 2012 Briganti nomogram score within the investigated population was 3% (2-8%). Median (95% Confidence Interval [CI]) follow-up was 95 (91.9-112.4) months. Disease progression occurred in 237 (22.6%) patients, who were more likely to have an increasing 2012 Briganti nomogram score (Hazard Ratio [HR]: 1.03; 95%CI: 1.01-1.81; p = 0.015), independently of unfavorable issues at clinical presentation. Moreover, the nomogram score stratified according to tertiles (<3% vs. 3-8% vs. ≥8%) hold significance beyond EAU risk categories: accordingly, the risk of disease progression increased as the score increased from the first (reference) to the second (HR: 1.50; 95%CI: 1.67-3.72; p < 0.001) up to the third (HR: 3.26; 95%CI: 2.26-4.72; p < 0.001) tertile. Conclusions: Beyond EAU risk categories, the 2012 Briganti nomogram represented an independent predictor of PCa progression after surgery. Likewise, as the nomogram score increased so patients were more likely to experience disease progression. Accordingly, it may allow further stratification of patients within each risk category to modulate appropriate treatment paradigms.
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Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Rossella Orlando
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Andrea Panunzio
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy; (A.P.); (A.T.)
| | - Alessandro Tafuri
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy; (A.P.); (A.T.)
| | - Alberto Baielli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Francesco Artoni
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Claudio Brancelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Luca Roggero
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Sonia Costantino
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Andrea Franceschini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Michele Boldini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Lorenzo Pierangelo Treccani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Francesca Montanaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Sebastian Gallina
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Alberto Bianchi
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Emanuele Serafin
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Giovanni Mazzucato
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Francesco Ditonno
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Mariana Finocchiaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Alessandro Veccia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Matteo Brunelli
- Department of Pathology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy;
| | - Vincenzo De Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Salvatore Siracusano
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Maria Angela Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Riccardo Bertolo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy; (R.O.); (A.B.); (F.A.); (C.B.); (L.R.); (S.C.); (A.F.); (M.B.); (L.P.T.); (F.M.); (S.G.); (A.B.); (E.S.); (G.M.); (F.D.); (M.F.); (A.V.); (R.R.); (V.D.M.); (M.A.C.); (R.B.); (A.A.)
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Porcaro AB, Bianchi A, Gallina S, Serafin E, Vidiri S, Veccia A, Rizzetto R, Ditonno F, Montanaro F, Baielli A, Artoni F, Marafioti Patuzzo G, Franceschini A, Brusa D, Princiotta A, Boldini M, Brunelli M, DE Marco V, Migliorini F, Cerruto MA, Antonelli A. High-volume surgeons decrease operating time in robot-assisted radical prostatectomy: results in 1229 patients. Minerva Urol Nephrol 2024; 76:312-319. [PMID: 38920011 DOI: 10.23736/s2724-6051.24.05617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND The aim is to evaluate factors impacting operating time (OT) during robot-assisted radical prostatectomy (RARP) with or without extended pelvic lymph node dissection (ePLND) for prostate cancer. METHODS Overall, 1289 patients underwent RARP from January 2013 to December 2021. ePLND was performed in 825 cases. Factors potentially associated with OT variations were assessed. Three low-volume (LVS) and two high-volume surgeons (HVS) performed the procedures. A linear regression model was computed to assess associations with OT variations. RESULTS When RARP was performed by HVS an OT decrease was observed independently by significant clinical (Body Mass Index [BMI]; prostate volume [PV]) and anatomical/perioperative features (prostate weight [PW]; intraoperative blood loss [BL]) both in clinical (change in OT: -42.979 minutes; 95% CI: -51.789; -34.169; P<0.0001) and anatomical/perioperative models (change in OT: -40.020 minutes; 95% CI: -48.494; -31.587; P<0.0001). A decreased OT was observed in clinical (change in OT: -27.656 minutes; 95% CI: -33.449; -21.864; P<0.0001) and anatomical/perioperative (change in OT: -24.935 minutes; 95% CI: -30.562; -19.308; P<0.0001) models also in case of RARP with ePLND performed by HVS, independently by BMI, PV, PSA as well as for PW, seminal vesicle invasion, positive surgical margins, and BL. CONCLUSIONS In a tertiary academic referral center, OT decreased when RARP was performed by HVS, independently of adverse clinical and anatomical/perioperative factors. Available OT loads can be planned to optimize waiting lists, teaching tasks, operative costs, and surgeon's volume.
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Affiliation(s)
- Antonio B Porcaro
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy -
| | - Alberto Bianchi
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Sebastian Gallina
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Emanuele Serafin
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Stefano Vidiri
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Alessandro Veccia
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Francesco Ditonno
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Francesca Montanaro
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Alberto Baielli
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Francesco Artoni
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | | | - Andrea Franceschini
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Davide Brusa
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | | | - Michele Boldini
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Vincenzo DE Marco
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Maria A Cerruto
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
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Porcaro AB, Panunzio A, Orlando R, Tafuri A, Gallina S, Bianchi A, Serafin E, Mazzucato G, Montanaro F, Baielli A, Artoni F, Ditonno F, Roggero L, Franceschini A, Boldini M, Treccani LP, Veccia A, Rizzetto R, Brunelli M, De Marco V, Siracusano S, Cerruto MA, Bertolo R, Antonelli A. The 2012 Briganti nomogram predicts disease progression after surgery in high-risk prostate cancer patients. Arab J Urol 2024; 22:227-234. [PMID: 39355796 PMCID: PMC11441050 DOI: 10.1080/20905998.2024.2339062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/30/2024] [Indexed: 10/03/2024] Open
Abstract
Objectives We tested whether the 2012 Briganti nomogram for the risk of pelvic lymph node invasion (PLNI) may represent a predictor of disease progression after surgical management in high-risk (HR) prostate cancer (PCa) patients according to the European Association of Urology. Methods Between January 2013 and December 2021, HR PCa patients treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) were identified. The 2012 Briganti nomogram was evaluated as a continuous and categorical variable, which was dichotomized using the median. The risk of disease progression, defined as the event of biochemical recurrence and/or local recurrence/distant metastases was assessed by Cox regression models. Results Overall, 204 patients were identified. The median 2012 Briganti nomogram score resulted 12.0% (IQR: 6.0-22.0%). PLNI was detected in 57 (27.9%) cases. Compared to patients who had preoperatively a 2012 Briganti nomogram score ≤12%, those with a score >12% were more likely to present with higher percentage of biopsy positive cores, palpable tumors at digital rectal examination, high-grade cancers at prostate biopsies, and unfavorable pathology in the surgical specimen. At multivariable Cox regression analyses, disease progression, which occurred in 85 (41.7%) patients, was predicted by the 2012 Briganti nomogram score (HR: 1.02; 95%CI: 1.00-1.03; p = 0.012), independently by tumors presenting as palpable (HR: 1.78; 95%CI: 1.10.2.88; p = 0.020) or the presence of PLNI in the surgical specimen (HR: 3.73; 95%CI: 2.10-5.13; p = 0.012). Conclusions The 2012 Briganti nomogram represented an independent predictor of adverse prognosis in HR PCa patients treated with RARP and ePLND. As the score increased, so patients were more likely to experience disease progression, independently by the occurrence of PLNI. The association between the nomogram, unfavorable pathology and tumor behavior might turn out to be useful for selecting a subset of patients needing different treatment paradigms in HR disease.
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Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Rossella Orlando
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Sebastian Gallina
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Bianchi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emanuele Serafin
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Mazzucato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesca Montanaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Baielli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Artoni
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Ditonno
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luca Roggero
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Franceschini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Boldini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Siracusano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Bertolo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Siech C, Gruber A, Wenzel M, Humke C, Karakiewicz PI, Kluth LA, Chun FKH, Hoeh B, Mandel P. Cardiovascular Disease and Chronic Pulmonary Disease Increase the Risk of Short-Term Major Postoperative Complications after Robotic-Assisted Radical Prostatectomy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:173. [PMID: 38256433 PMCID: PMC10820446 DOI: 10.3390/medicina60010173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
Background and objectives: Certain comorbidities may be associated with a higher risk of complications after robotic-assisted radical prostatectomy. Material and Methods: Relying on a tertiary care database, we identified robotic-assisted radical prostatectomy patients (January 2014-March 2023). Short-term major postoperative complications were defined according to Clavien Dindo as ≥IIIa within 30 days after robotic-assisted radical prostatectomy. Results: Of 1148 patients, the rates of postoperative Clavien Dindo IIIa, Clavien Dindo IIIb, Clavien Dindo IVa, and Clavien Dindo IVb complications were 3.3%, 1.4%, 0.3%, and 0.2%, respectively. Of those, 28 (47%) had lymphoceles, and 8 (13%) had bleeding-associated complications. Patients with cardiovascular disease (8 vs. 4%) or chronic pulmonary disease (13 vs. 5%) were more likely to have complications. In multivariable logistic regression models, cardiovascular disease (odds ratio: 1.78; p = 0.046) and chronic pulmonary disease (odds ratio: 3.29; p = 0.007) remained associated with an increased risk of postoperative complications. Conclusions: Complications after robotic-assisted radical prostatectomy are predominantly manageable without anesthesia. Concomitant cardiovascular disease and chronic pulmonary disease were both associated with a higher risk of postoperative complications.
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Affiliation(s)
- Carolin Siech
- Goethe University Frankfurt, University Hospital, Department of Urology, 60629 Frankfurt am Main, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X3E4, Canada
| | - Antonia Gruber
- Goethe University Frankfurt, University Hospital, Department of Urology, 60629 Frankfurt am Main, Germany
| | - Mike Wenzel
- Goethe University Frankfurt, University Hospital, Department of Urology, 60629 Frankfurt am Main, Germany
| | - Clara Humke
- Goethe University Frankfurt, University Hospital, Department of Urology, 60629 Frankfurt am Main, Germany
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X3E4, Canada
| | - Luis A. Kluth
- Goethe University Frankfurt, University Hospital, Department of Urology, 60629 Frankfurt am Main, Germany
| | - Felix K. H. Chun
- Goethe University Frankfurt, University Hospital, Department of Urology, 60629 Frankfurt am Main, Germany
| | - Benedikt Hoeh
- Goethe University Frankfurt, University Hospital, Department of Urology, 60629 Frankfurt am Main, Germany
| | - Philipp Mandel
- Goethe University Frankfurt, University Hospital, Department of Urology, 60629 Frankfurt am Main, Germany
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Porcaro AB, Rizzetto R, Bianchi A, Gallina S, Serafin E, Panunzio A, Tafuri A, Cerrato C, Migliorini F, Zecchini Antoniolli S, Novella G, De Marco V, Brunelli M, Siracusano S, Cerruto MA, Polati E, Antonelli A. American Society of Anesthesiologists (ASA) physical status system predicts the risk of postoperative Clavien–Dindo complications greater than one at 90 days after robot-assisted radical prostatectomy: final results of a tertiary referral center. J Robot Surg 2022; 17:987-993. [DOI: 10.1007/s11701-022-01505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/21/2022] [Indexed: 11/28/2022]
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