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Mattes MD. Overview of Radiation Therapy in the Management of Localized and Metastatic Prostate Cancer. Curr Urol Rep 2024; 25:181-192. [PMID: 38861238 DOI: 10.1007/s11934-024-01217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE OF REVIEW The goal is to describe the evolution of radiation therapy (RT) utilization in the management of localized and metastatic prostate cancer. RECENT FINDINGS Long term data for a variety of hypofractionated definitive RT dose-fractionation schemes has matured, allowing patients and providers many standard-of-care options to choose from. Post-prostatectomy, adjuvant RT has largely been replaced by an early salvage approach. Multiparametric MRI and PSMA PET have enabled increasingly targeted RT delivery to the prostate and oligometastatic tumors. Areas of active investigation include determining the value of proton beam therapy and perirectal spacers, and optimally incorporate genomic tumor profiling and next generation hormonal therapies with RT in the curative setting. The use of radiation therapy to treat prostate cancer is rapidly evolving. In the coming years, there will be continued improvements in a variety of areas to enhance the value of RT in multidisciplinary prostate cancer management.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
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Björklund J, Rautiola J, Zelic R, Edgren G, Bottai M, Nilsson M, Vincent PH, Fredholm H, Falconer H, Sjövall A, Nilsson PJ, Wiklund P, Aly M, Akre O. Risk of Venous Thromboembolic Events After Surgery for Cancer. JAMA Netw Open 2024; 7:e2354352. [PMID: 38306100 PMCID: PMC10837742 DOI: 10.1001/jamanetworkopen.2023.54352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/11/2023] [Indexed: 02/03/2024] Open
Abstract
Importance The risks and benefits of thromboprophylaxis therapy after cancer surgery are debated. Studies that determine thrombosis risk after cancer surgery with high accuracy are needed. Objectives To evaluate 1-year risk of venous thromboembolic events after major cancer surgery and how these events vary over time. Design, Setting, and Participants This register-based retrospective observational matched cohort study included data on the full population of Sweden between 1998 and 2016. All patients who underwent major surgery for cancer of the bladder, breast, colon or rectum, gynecologic organs, kidney and upper urothelial tract, lung, prostate, or gastroesophageal tract were matched in a 1:10 ratio with cancer-free members of the general population on year of birth, sex, and county of residence. Data were analyzed from February 13 to December 5, 2023. Exposure Major surgery for cancer. Main Outcomes and Measures The main outcome was incidence of venous thromboembolic events within 1 year after the surgery. Crude absolute risks and risk differences of events within 1 year and adjusted time-dependent cause-specific hazard ratios (HRs) of postdischarge events were calculated. Results A total of 432 218 patients with cancer (median age, 67 years [IQR, 58-75 years]; 68.7% women) and 4 009 343 cancer-free comparators (median age, 66 years [IQR, 57-74 years]; 69.3% women) were included in the study. The crude 1-year cumulative risk of pulmonary embolism was higher among the cancer surgery population for all cancers, with the following absolute risk differences: for bladder cancer, 2.69 percentage points (95% CI, 2.33-3.05 percentage points); for breast cancer, 0.59 percentage points (95% CI 0.55-0.63 percentage points); for colorectal cancer, 1.57 percentage points (95% CI, 1.50-1.65 percentage points); for gynecologic organ cancer, 1.32 percentage points (95% CI, 1.22-1.41 percentage points); for kidney and upper urinary tract cancer, 1.38 percentage points (95% CI, 1.21-1.55 percentage points); for lung cancer, 2.61 percentage points (95% CI, 2.34-2.89 percentage points); for gastroesophageal cancer, 2.13 percentage points (95% CI, 1.89-2.38 percentage points); and for prostate cancer, 0.57 percentage points (95% CI, 0.49-0.66 percentage points). The cause-specific HR of pulmonary embolism comparing patients who underwent cancer surgery with matched comparators peaked just after discharge and generally plateaued 60 to 90 days later. At 30 days after surgery, the HR was 10 to 30 times higher than in the comparison cohort for all cancers except breast cancer (colorectal cancer: HR, 9.18 [95% CI, 8.03-10.50]; lung cancer: HR, 25.66 [95% CI, 17.41-37.84]; breast cancer: HR, 5.18 [95% CI, 4.45-6.05]). The hazards subsided but never reached the level of the comparison cohort except for prostate cancer. Similar results were observed for deep vein thrombosis. Conclusions and Relevance This cohort study found an increased rate of venous thromboembolism associated with cancer surgery. The risk persisted for about 2 to 4 months postoperatively but varied between cancer types. The increased rate is likely explained by the underlying cancer disease and adjuvant treatments. The results highlight the need for individualized venous thromboembolism risk evaluation and prophylaxis regimens for patients undergoing different surgery for different cancers.
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Affiliation(s)
- Johan Björklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Juhana Rautiola
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Renata Zelic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Fredholm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Annika Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Per J. Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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Rais G, Vassallo P, Schorer R, Bollen Pinto B, Putzu A. Patent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis. Br J Anaesth 2022; 129:898-908. [PMID: 35987705 DOI: 10.1016/j.bja.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery. The magnitude of this association was assessed in a systematic review and meta-analysis. METHODS Electronic databases were searched up to June 2022 for studies assessing the association between patent foramen ovale and perioperative stroke in adult patients undergoing noncardiac surgery. The primary analysis was limited to studies reporting effect estimates adjusted for significant clinical confounders. We calculated the adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS We included nine retrospective and two prospective observational studies, including 21 257 082 patients. The presence of a patent foramen ovale was independently associated with stroke at 30 days after surgery (aOR=6.68 [95% CI: 3.51-12.73]; P<0.001) and at longest follow-up available (aOR=7.36 [95% CI: 3.56-15.21]; P<0.001). The odds of stroke at 30 days varied according to surgical specialty: neurosurgery (aOR=4.52 [95% CI: 3.17-6.43]), vascular surgery (aOR=7.15 [95% CI: 2.52-20.22]), thoracic surgery (aOR=10.64 [95% CI: 5.97-18.98]), orthopaedic surgery (aOR=11.85 [95% CI: 5.38-26.08]), general surgery (aOR=14.40 [95% CI: 10.88-19.06]), and genitourinary surgery (aOR=17.28 [95% CI: 10.36-28.84]). CONCLUSIONS The presence of a patent foramen ovale is associated with a large and consistent increase in odds of stroke across all explored surgical settings. Prospective trials should further explore this association by systematically assessing patent foramen ovale and stroke prevalence and identifying a specific population at risk. This is crucial for the elaboration of prevention plans and may improve perioperative outcomes.
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Affiliation(s)
- Gael Rais
- Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Paola Vassallo
- Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne, Switzerland
| | - Raoul Schorer
- Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Bernardo Bollen Pinto
- Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Putzu
- Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.
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Balabanova Y, Farahmand B, Garmo H, Stattin P, Brobert G. Risk of venous thromboembolism in men with prostate cancer compared with men in the general population: a nationwide population-based cohort study in Sweden. BMJ Open 2022; 12:e055485. [PMID: 35606159 PMCID: PMC9150160 DOI: 10.1136/bmjopen-2021-055485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the additional risk of venous thromboembolism (VTE) in men with prostate cancer compared with men without prostate cancer in Sweden. DESIGN Nationwide cohort study following 92 105 men with prostate cancer and 466 241 men without prostate cancer (comparison cohort) matched 5:1 by birth year and residential region. SETTING The male general population of Sweden (using the Nationwide Prostate Cancer data Base Sweden). PRIMARY AND SECONDARY OUTCOME MEASURES Crude incidence proportion ratios (IPRs) comparing the incidence of VTE in men with prostate cancer and men in the comparison cohort. Cox regression was used to calculate HRs for VTE adjusted for confounders. RESULTS 2955 men with prostate cancer and 9774 men in the comparison cohort experienced a first VTE during a median of 4.5 years' follow-up. Deep vein thrombosis (DVT) accounted for 52% of VTE cases in both cohorts. Median time from start of follow-up to VTE was 2.5 years (IQR 0.9-4.7) in the prostate cancer cohort and 2.9 years (IQR 1.3-5.0) in the comparison cohort. Crude incidence rates of VTE per 1000 person-years were 6.54 (95% CI 6.31 to 6.78) in the prostate cancer cohort (n=2955 events) and 4.27 (95% CI 4.18 to 4.35) in the comparison cohort (n=9774 events). The IPR decreased from 2.53 (95% CI 2.26 to 2.83) at 6 months to 1.59 (95% CI 1.52 to 1.67) at 5 years' follow-up. Adjusted HRs were 1.48 (95% CI 1.39 to 1.57) for DVT and 1.47 (95% CI 1.39 to 1.56) for pulmonary embolism after adjustment for patient characteristics. CONCLUSIONS Swedish men with prostate cancer had a mean 50% increased risk of VTE during the 5 years following their cancer diagnosis compared with matched men free of prostate cancer. Physicians should be mindful of this marked increase in VTE risk in men with prostate cancer to help ensure timely diagnosis.
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Affiliation(s)
| | | | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Urology, Uppsala University, Uppsala, Sweden
| | - Pär Stattin
- School of Cancer and Pharmaceutical Sciences, Urology, Uppsala University, Uppsala, Sweden
| | - Gunnar Brobert
- Integrated Evidence Generation, Bayer AB, Stockholm, Sweden
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Hoek M, Schultz M, Alummoottil S, Aneck-Hahn N, Mathabe K, Bester J. Ex vivo Vitamin D supplementation improves viscoelastic profiles in prostate cancer patients. Clin Hemorheol Microcirc 2022; 81:221-232. [DOI: 10.3233/ch-211353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Increased risk of thromboembolic events is associated with prostate cancer, specifically linked to activation of tissue factor. Vitamin D has potential anticoagulant effects by the downregulation of tissue factor expression. OBJECTIVES: To evaluate the effects on clot formation, the morphological and viscoelastic profiles of prostate cancer patients, before and after ex vivo supplementation of Vitamin D was studied. METHODS: Participants were recruited into a metastatic, non-metastatic and reference group. Whole blood samples were treated ex vivo with a dose of 0.5μg/kg Calcitriol. Clot kinetics were assessed using Thromboelastography ®. Morphology of the blood components were studied using scanning electron microscopy (SEM). RESULTS: Results from the Thromboelastography ® and SEM indicated no major differences between the non-metastatic group before and after treatment compared to the reference group. The Thromboelastography ® showed that the metastatic group had an increased viscoelastic profile relating to a hypercoagulable state. Visible changes with regards to platelet activation and fibrin morphology were demonstrated with SEM analysis of the metastatic group. The viscoelastic and morphological properties for the non-metastatic group after treatment improved to be comparable to the reference group. CONCLUSION: Vitamin D supplementation may lead to a more favorable viscoelastic profile, with less dangerous clots forming.
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Affiliation(s)
- Marinka Hoek
- Department of Urology, University of Pretoria, Pretoria, South Africa
| | - Michelle Schultz
- Department of Physiology, University of Pretoria, Pretoria, South Africa
| | - Sajee Alummoottil
- Department of Physiology, University of Pretoria, Pretoria, South Africa
| | - Natalie Aneck-Hahn
- Department of Urology, University of Pretoria, Pretoria, South Africa
- Environmental Chemical Pollution and Health Research Unit, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Kgomotso Mathabe
- Department of Urology, University of Pretoria, Pretoria, South Africa
| | - Janette Bester
- Department of Physiology, University of Pretoria, Pretoria, South Africa
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Balabanova Y, Farahmand B, Stattin P, Garmo H, Brobert G. Population-based study of long-term anticoagulation for treatment and secondary prophylaxis of venous thromboembolism in men with prostate cancer in Sweden. BMC Urol 2022; 22:15. [PMID: 35109829 PMCID: PMC8809008 DOI: 10.1186/s12894-022-00967-z] [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: 06/10/2021] [Accepted: 01/21/2022] [Indexed: 11/14/2022] Open
Abstract
Background Epidemiological data on anticoagulation for venous thromboembolism (VTE) in prostate cancer are sparse. We aimed to investigate associations between anticoagulation duration and risks of VTE recurrence after treatment cessation and major on-treatment bleeding in men with prostate cancer in Sweden. Methods Using nationwide prostate cancer registry and prescribing data, we followed 1413 men with VTE and an outpatient anticoagulant prescription following prostate cancer diagnosis. Men were followed to identify cases of recurrent VTE, and hospitalized major bleeding. We calculated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) to quantify the association between anticoagulation duration (reference ≤ 3 months) and recurrent VTE using Cox regression. We estimated 1-year cumulative incidences of major bleedings from anticoagulation initiation. Results The outpatient anticoagulation prescribed was parenteral (64%), direct oral anticoagulant (31%), and vitamin K antagonist (20%). Median duration of anticoagulation was 7 months. Adjusted HRs (95% CI) for off-treatment recurrent pulmonary embolism (PE) were 0.32 (0.09–1.15) for > 3–6 months’ duration, 0.21 (0.06–0.69) for > 6–9 months and 0.16 (0.05–0.55) for > 9 months; corresponding HRs for deep vein thrombosis (DVT) were 0.67 (0.27–1.66), 0.80 (0.31–2.07), and 1.19 (0.47–3.02). One-year cumulative incidences of intracranial, gastrointestinal and urogenital bleeding were 0.9%, 1.7%, 3.0% during treatment, and 1.2%, 0.9%, 1.6% after treatment cessation. Conclusion The greatest possible benefit in reducing recurrent VTE risk occurred with > 9 months anticoagulation for PE and > 3–6 months for DVT, but larger studies are needed to confirm this. Risks of major bleeding were low overall. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-00967-z.
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Affiliation(s)
| | | | - Pär Stattin
- Department of Surgical Sciences, Urology, Uppsala University, Uppsala, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Urology, Uppsala University, Uppsala, Sweden
| | - Gunnar Brobert
- Integrated Evidence Generation, Bayer AB, Stockholm, Sweden
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Influence of steep Trendelenburg position on postoperative complications: a systematic review and meta-analysis. J Robot Surg 2021; 16:1233-1247. [PMID: 34972981 PMCID: PMC9606098 DOI: 10.1007/s11701-021-01361-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022]
Abstract
Intraoperative physiologic changes related to the steep Trendelenburg position have been investigated with the widespread adoption of robot-assisted pelvic surgery (RAPS). However, the impact of the steep Trendelenburg position on postoperative complications remains unclear. We conducted a meta-analysis to compare RAPS to laparoscopic/open pelvic surgery with regards to the rates of venous thromboembolism (VTE), cardiac, and cerebrovascular complications. Meta-regression was performed to evaluate the influence of confounding risk factors. Ten randomized controlled trials (RCTs) and 47 non-randomized controlled studies (NRSs), with a total of 380,125 patients, were included. Although RAPS was associated with a decreased risk of VTE and cardiac complications compared to laparoscopic/open pelvic surgery in NRSs [risk ratio (RR), 0.59; 95% CI 0.51–0.72, p < 0.001 and RR 0.93; 95% CI 0.58–1.50, p = 0.78, respectively], these differences were not confirmed in RCTs (RR 0.92; 95% CI 0.52–1.62, p = 0.77 and RR 0.93; 95% CI 0.58–1.50, p = 0.78, respectively). In subgroup analyses of laparoscopic surgery, there was no significant difference in the risk of VTE and cardiac complications in both RCTs and NRSs. In the meta-regression, none of the risk factors were found to be associated with heterogeneity. Furthermore, no significant difference was observed in cerebrovascular complications between RAPS and laparoscopic/open pelvic surgery. Our meta-analysis suggests that the steep Trendelenburg position does not seem to affect postoperative complications and, therefore, can be considered safe with regard to the risk of VTE, cardiac, and cerebrovascular complications. However, proper individualized preventive measures should still be implemented during all surgeries including RAPS to warrant patient safety.
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Liapi M, Jayne D, Merkel PA, Segelmark M, Mohammad AJ. Venous thromboembolism in ANCA-associated vasculitis: a population-based cohort study. Rheumatology (Oxford) 2021; 60:4616-4623. [PMID: 33506869 DOI: 10.1093/rheumatology/keab057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/04/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine incidence rate and predictors of venous thromboembolic events (VTE) in a population-based cohort with ANCA-associated vasculitis (AAV). METHODS The study comprised 325 patients diagnosed with AAV from 1997 to 2016. All cases of VTE from prior to vasculitis diagnosis to the end of the study period were identified. The BVAS was used to assess disease activity at diagnosis. Venous thromboembolisms occurring in a period beginning 3 months prior to AAV diagnosis were considered to be AAV-related. The standardized incidence ratio (SIR) and 95% CI of VTE were calculated using the incidence rate in the general population. RESULTS Fifty-nine patients (18%) suffered 64 VTE events. Of these, 48 (81%) suffered AAV-related VTE [deep vein thrombosis (n = 23), pulmonary embolism (n = 18) and other (n = 9)]. The incidence rate of AAV-related VTE was 2.4 per 100 person-years (95% CI 1.7, 3.0) during 2039 person-years of follow-up. The incidence during the first 3 months post-AAV diagnosis was 20.4 per 100 person-years (95% CI 11.5, 29.4), decreasing to 8.9 (95% CI 0.2, 17.6) and 1.5 (95% CI 0.0, 3.5) in months 4-6 and months 7-12 post-AAV diagnosis, respectively. The SIR was 34.2 (95% CI 20.2, 48.1) for deep vein thrombosis and 10.4 (95% CI 5.6, 15.1) for pulmonary embolism. In multivariate Cox regression analyses, only age and BVAS were predictive of VTE. CONCLUSIONS The incidence rate and SIR of AAV-related VTE is high, and higher early in the course of the disease. Vasculitis activity and age are positively associated with VTE.
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Affiliation(s)
- Matina Liapi
- Department of Clinical Sciences Lund, Section of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine.,Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mårten Segelmark
- Department of Clinical Sciences Lund, Lund University, Nephrology, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Section of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
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Urabe F, Kimura S, Iwatani K, Yasue K, Koike Y, Tashiro K, Tsuzuki S, Sasaki H, Kimura T, Egawa S. The Impact of ABO Blood Type on Developing Venous Thromboembolism in Cancer Patients: Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10163692. [PMID: 34441987 PMCID: PMC8397199 DOI: 10.3390/jcm10163692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 01/11/2023] Open
Abstract
The impact of ABO blood type in the development of venous thromboembolism in cancer patients remains controversial. To develop a sense of the current opinion in this area, we conducted a systematic review and meta-analysis. In March 2021, we performed a systematic search of PubMed, the Cochrane library, and Scopus for studies that compared cancer patients who had a blood type of either O or non-O (A, B, and AB). Our objective was to use multivariate logistic regression analysis to determine how ABO blood type was associated with the development of venous thromboembolism. Our selection criteria were met by a total of nine studies in 25,884 patients for the systematic review and five studies in 22,777 patients for the meta-analysis. In cancer patients, we found that non-O blood type was associated with a nearly two-fold increase in risk of venous thromboembolism (pooled OR: 1.74, 95% CI: 1.44–2.10). Additionally, among the eligible patients, 21,889 patients were post-operative urological cancer patients. In these patients, the analysis also showed an association between non-O blood type and increasing risk of venous thromboembolism after pelvic surgery for malignancy (pooled OR: 1.73, 95% CI: 1.36–2.20). Our meta-analysis suggested that non-O blood type is a risk factor for venous thromboembolism among patients with cancer. As blood type is routinely determined preoperatively by objective and standardized methods, we anticipate that our results will be useful for managing venous thromboembolism in cancer patients, especially after pelvic surgery for urological cancers.
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Klaassen Z, Wallis CJD, Lavallée LT, Violette PD. Perioperative venous thromboembolism prophylaxis in prostate cancer surgery. World J Urol 2019; 38:593-600. [DOI: 10.1007/s00345-019-02705-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/25/2019] [Indexed: 01/31/2023] Open
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Wallerstedt Lantz A, Stranne J, Tyritzis SI, Bock D, Wallin D, Nilsson H, Carlsson S, Thorsteinsdottir T, Gustafsson O, Hugosson J, Bjartell A, Wiklund P, Steineck G, Haglind E. 90-Day readmission after radical prostatectomy-a prospective comparison between robot-assisted and open surgery. Scand J Urol 2019; 53:26-33. [PMID: 30727795 DOI: 10.1080/21681805.2018.1556729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: All types of surgery are associated with complications. The debate is ongoing whether robot-assisted radical prostatectomy can lower this risk compared to open surgery. The objective of the present study was to evaluate post-operative adverse events leading to readmissions, using clinical records to classify these adverse events systematically. Materials and methods: A prospective controlled trial of men who underwent robot-assisted laparoscopic (RALP) or retropubic radical prostatectomy (RRP) at 14 departments of Urology (LAPPRO) between 2008 and 2011. Data on all readmissions within 3 months of surgery were collected from the Patient registry, Swedish Board of Health and Welfare. For each readmission the highest Clavien-Dindo grade was listed. Results: A total of 4003 patients were included in the LAPPRO trial and, after applying exclusion criteria, 3706 patients remained for analyses. The results showed no statistically significant difference in the overall readmission rates (8.1 vs. 7.1%) or readmission due to major complications (Clavien-Dindo ≥3b, 1.7 vs. 1.9%) between RALP and RRP within 90 days after surgery. Patients subjected to lymph-node dissection (LND) had twice the risk for readmission as men not undergoing LND, irrespective RALP or RRP technique. Blood transfusion was significantly more frequent during and within 30 days of RRP surgery (16 vs. 4%). Abdominal symptoms were more common after RALP. Conclusions: There is a substantial risk for hospital readmission after prostate-cancer surgery, regardless of technique; although major complications are rare. Regardless of surgical technique, attention should be focused on specific types of complications.
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Affiliation(s)
- Anna Wallerstedt Lantz
- a Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet, Stockholm , Solna , Sweden
| | - Johan Stranne
- b Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Stavros I Tyritzis
- a Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet, Stockholm , Solna , Sweden
| | - David Bock
- c Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - David Wallin
- c Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Hanna Nilsson
- c Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Stefan Carlsson
- a Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet, Stockholm , Solna , Sweden
| | - Thordis Thorsteinsdottir
- d Landspitali National University Hospital and the Faculty of Nursing , University of Iceland , Reykjavic , Iceland
| | - Ove Gustafsson
- e Department of Clinical Science, Intervention and Technology , Karolinska Institutet, Stockholm , Solna , Sweden
| | - Jonas Hugosson
- b Department of Urology, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Anders Bjartell
- f Department of Urology , Skåne University Hospital, Lund University , Lund , Sweden
| | - Peter Wiklund
- a Department of Molecular Medicine and Surgery, Section of Urology , Karolinska Institutet, Stockholm , Solna , Sweden
| | - Gunnar Steineck
- g Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.,h Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology , Karolinska Institutet , Stockholm, Solna , Sweden
| | - Eva Haglind
- c Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
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12
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Chalouhy C, Gurram S, Ghavamian R. Current controversies on the role of lymphadenectomy for prostate cancer. Urol Oncol 2018; 37:219-226. [PMID: 30579787 DOI: 10.1016/j.urolonc.2018.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/20/2018] [Accepted: 11/19/2018] [Indexed: 01/11/2023]
Abstract
Lymph node dissection is part of the standard treatment protocol for various cancers, but its role in prostate cancer has been debatable for some time. Pelvic lymphadenectomy has been shown to better help stage prostate cancer patients, but has yet to be definitively proven to be of any benefit for survival. Various templates for lymph node dissections exist, and though some national guidelines have endorsed an extended pelvic node dissection, the choice of template is still controversial. Pelvic lymphadenectomy may lead to a slightly higher rate complications and operative time, and their use must be judiciously applied to patients with a high enough risk of lymph node involvement. We present a comprehensive review of the literature regarding the benefits and harms of lymph node dissection in prostate cancer.
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Affiliation(s)
| | - Sandeep Gurram
- The Smith Institute for Urology, Zucker School of Medicine Hofstra/Northwell, New Hyde Park, NY
| | - Reza Ghavamian
- The Smith Institute for Urology, Zucker School of Medicine Hofstra/Northwell, New Hyde Park, NY.
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13
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Zipple M, Itenberg E. Improving adherence to recommended venous thromboembolic prophylaxis in abdominal and pelvic oncologic surgery. Surgery 2018; 164:900-904. [PMID: 30076024 DOI: 10.1016/j.surg.2018.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We reviewed rates of adherence to the American College of Chest Physicians guidelines for venous thromboembolism prophylaxis in abdominal and pelvic oncologic surgery at our community hospital compared with rates statewide. METHODS We completed a retrospective review of adult patients undergoing abdominal or pelvic oncologic surgery from January 1, 2015 to December 31, 2016, compared with statewide data from the Michigan Surgical Quality Collaborative during the same period. Educational intervention included creation of hospital guidelines and presentations reviewing American College of Chest Physicians guidelines and hospital adherence rates. A short-term observation of extended-duration venous thromboembolism prophylaxis rates was completed after the intervention. RESULTS The rates of in-hospital venous thromboembolism prophylaxis (general surgery: 93.7%, n = 106; gynecology: 40.0%, n = 32) were comparable to statewide in-hospital prophylaxis rates (89.6% general surgery, 41.8% gynecology). Five patients (4.5%) were prescribed extended-duration prophylaxis, which was lower than statewide rates (20.3%). In comparison, there was a statistically significant improvement in the rate of extended prophylaxis in the 6 months following intervention to 23.6% (n = 5, P < .0005). CONCLUSION The rates of extended-duration venous thromboembolism prophylaxis prescription were lower than the state average at our community hospital; however, the short-term evaluation revealed significant improvement after intervention.
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Affiliation(s)
- Monica Zipple
- Department of Surgery, Saint Joseph Mercy Oakland, Pontiac, Michigan
| | - Edwin Itenberg
- Department of Surgery, Saint Joseph Mercy Oakland, Pontiac, Michigan.
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14
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Shi A, Huang J, Wang X, Li M, Zhang J, Chen Y, Huang Y. Postoperative D-dimer predicts venous thromboembolism in patients undergoing urologic tumor surgery. Urol Oncol 2018; 36:307.e15-307.e21. [PMID: 29599070 DOI: 10.1016/j.urolonc.2018.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/13/2018] [Accepted: 03/05/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE We examined the incidence of pulmonary thromboembolism (PE) and deep venous thromboembolism (DVT) in patients who underwent urologic tumor surgery. The aim of this study was to investigate the postoperative D-dimer for prediction of venous thromboembolism events (VTE), as well as to identify other risk factors associated with the occurrence of thromboembolisms. PATIENTS AND METHODS This was a prospective observational cohort study, which included 1,269 patients who underwent major urologic tumor surgery, from August 2015 to February 2017, at our center. Data comprising age, sex, body mass index, Charlson comorbidity index, type of surgery, Caprini score, postoperative D-dimer levels, and other laboratory tests were collected for analyses. Lower limb venous ultrasound was performed before surgery and the day before hospital discharge to measure DVT. Computerized tomography or ventilation/perfusion lung scan was applied to detect PE. RESULTS The overall incidence of VTE was 2.4% (31 cases) in 1,269 patients, consisting of 23 PE events and 9 DVT events. Patients undergoing radical cystectomy were most likely to suffer VTE (4.3%). The optimal cutoff value for postoperative D-dimer was 0.98μg/ml, according to the receiver operating characteristic curve analysis, with a sensitivity of 83.9%, and a specificity of 80.0%. On multivariate analysis, hypertension (odds ratio, OR = 2.5, 95% CI: 1.1-5.7; P = 0.026), Charlson comorbidity index ≥ 2 (OR = 5.6, 95% CI: 2.2-14.6; P<0.001), and D-dimer lever ≥ 1μg/ml on postoperative day 1 (OR = 12.52, 95% CI: 4.6-35.2; P<0.001) were independently associated with VTE after urologic tumor surgery. CONCLUSIONS The overall incidence of urologic-tumor-surgery-associated VTE in an Asian population is similar to those reported in European and North American series. Elevated D-dimer early after operation is an independent predictor of VTE in patients undergoing urologic tumor surgery. In addition, hypertension and the Charlson comorbidity index are both important clinical risk factors. The Caprini score recommended by the guideline is inadequate in this study population. The postoperative D-dimer plasma level is a more reliable marker for identifying patients at high-risk of developing venous thromboembolisms.
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Affiliation(s)
- An Shi
- Department of Urology, RenJi Hospital affiliated to Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Jiwei Huang
- Department of Urology, RenJi Hospital affiliated to Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Xun Wang
- Department of Urology, RenJi Hospital affiliated to Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Mingyang Li
- Department of Urology, RenJi Hospital affiliated to Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Jin Zhang
- Department of Urology, RenJi Hospital affiliated to Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Yonghui Chen
- Department of Urology, RenJi Hospital affiliated to Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Yiran Huang
- Department of Urology, RenJi Hospital affiliated to Shanghai Jiao Tong University Medical School, Shanghai, China.
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Tikkinen KAO, Craigie S, Agarwal A, Violette PD, Novara G, Cartwright R, Naspro R, Siemieniuk RAC, Ali B, Eryuzlu L, Geraci J, Winkup J, Yoo D, Gould MK, Sandset PM, Guyatt GH. Procedure-specific Risks of Thrombosis and Bleeding in Urological Cancer Surgery: Systematic Review and Meta-analysis. Eur Urol 2017; 73:242-251. [PMID: 28342641 DOI: 10.1016/j.eururo.2017.03.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/03/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT Pharmacological thromboprophylaxis involves balancing a lower risk of venous thromboembolism (VTE) against a higher risk of bleeding, a trade-off that critically depends on the risks of VTE and bleeding in the absence of prophylaxis (baseline risk). OBJECTIVE To provide estimates of the baseline risk of symptomatic VTE and bleeding requiring reoperation in urological cancer surgery. EVIDENCE ACQUISITION We identified contemporary observational studies reporting symptomatic VTE or bleeding after urological procedures. We used studies with the lowest risk of bias and accounted for use of thromboprophylaxis and length of follow-up to derive best estimates of the baseline risks within 4 wk of surgery. We used the GRADE approach to assess the quality of the evidence. EVIDENCE SYNTHESIS We included 71 studies reporting on 14 urological cancer procedures. The quality of the evidence was generally moderate for prostatectomy and cystectomy, and low or very low for other procedures. The duration of thromboprophylaxis was highly variable. The risk of VTE in cystectomies was high (2.6-11.6% across risk groups) whereas the risk of bleeding was low (0.3%). The risk of VTE in prostatectomies varied by procedure, from 0.2-0.9% in robotic prostatectomy without pelvic lymph node dissection (PLND) to 3.9-15.7% in open prostatectomy with extended PLND. The risk of bleeding was 0.1-1.0%. The risk of VTE following renal procedures was 0.7-2.9% for low-risk patients and 2.6-11.6% for high-risk patients; the risk of bleeding was 0.1-2.0%. CONCLUSIONS Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without PLND in low-risk patients). For "close call" procedures, decisions will depend on values and preferences with regard to VTE and bleeding. PATIENT SUMMARY Clinicians often give blood thinners to patients to prevent blood clots after surgery for urological cancer. Unfortunately, blood thinners also increase bleeding. This study provides information on the risk of clots and bleeding that is crucial in deciding for or against giving blood thinners.
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Affiliation(s)
- Kari A O Tikkinen
- Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Samantha Craigie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Philippe D Violette
- Department of Surgery, Division of Urology, Woodstock General Hospital, Woodstock, ON, Canada; McMaster Department of Surgery Division of Urology, Hamilton, ON, Canada
| | - Giacomo Novara
- Department of Surgical, Oncological, and Gastroenterological Sciences, Urology Clinic, University of Padua, Padua, Italy
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Urogynaecology, St Mary's Hospital, London, UK
| | - Richard Naspro
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bassel Ali
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Leyla Eryuzlu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Johanna Geraci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Judi Winkup
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Daniel Yoo
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Per Morten Sandset
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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16
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Prostate Cancer Radiation Therapy and Risk of Thromboembolic Events. Int J Radiat Oncol Biol Phys 2017; 97:1026-1031. [PMID: 28332985 DOI: 10.1016/j.ijrobp.2017.01.218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/13/2017] [Accepted: 01/21/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the risk of thromboembolic disease (TED) after radiation therapy (RT) with curative intent for prostate cancer (PCa). PATIENTS AND METHODS We identified all men who received RT as curative treatment (n=9410) and grouped according to external beam RT (EBRT) or brachytherapy (BT). By comparing with an age- and county-matched comparison cohort of PCa-free men (n=46,826), we investigated risk of TED after RT using Cox proportional hazard regression models. The model was adjusted for tumor characteristics, demographics, comorbidities, PCa treatments, and known risk factors of TED, such as recent surgery and disease progression. RESULTS Between 2006 and 2013, 6232 men with PCa received EBRT, and 3178 underwent BT. A statistically significant association was found between EBRT and BT and risk of pulmonary embolism in the crude analysis. However, upon adjusting for known TED risk factors these associations disappeared. No significant associations were found between BT or EBRT and deep venous thrombosis. CONCLUSION Curative RT for prostate cancer using contemporary methodologies was not associated with an increased risk of TED.
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Geahchan N, Basile M, Tohmeh M. Venous thromboembolism prophylaxis in patients undergoing abdominal and pelvic cancer surgery: adherence and compliance to ACCP guidelines in DIONYS registry. SPRINGERPLUS 2016; 5:1541. [PMID: 27652114 PMCID: PMC5020030 DOI: 10.1186/s40064-016-3057-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 05/30/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major health care problem resulting in significant mortality, morbidity and increase in medical expenses. Patients with malignant diseases represent a high risk population for VTE. The American College of Chest Physicians (ACCP) proposed, since 1986, prophylaxis guidelines that are unequally respected in surgical practice. METHODS DIONYS is a multinational, longitudinal and non-interventional registry including patients having undergone abdominal or pelvic surgery for cancer in Latin America, Africa and the Middle East. Patients were evaluated with regard to VTE prophylaxis, during three consecutive visits, for their adherence to ACCP 2008 guidelines. Data were collected on type and duration of VTE prophylaxis, adherence to guidelines, and compliance with prescriptions, complications and possible reasons for omission of prophylaxis. RESULTS Between 2011 and June 2012, 921 adult patients were included and divided into abdominal (435), pelvic (390) and combined abdominal and pelvic surgery (96), 65.4 % being females. VTE prophylaxis was prescribed to 90 % of patients during hospitalization and to 28.3 % after hospital discharge. Prescriptions adhered to ACCP guidelines in 73.9 % of patients during hospitalization and 18.9 % after discharge. The reason of non-adherence was mainly the clinical judgment by the physician that the patient did not need a prophylaxis. The most commonly prescribed type of prophylaxis was pharmacological (low molecular weight heparin). CONCLUSION A wide gap exists between VTE prophylaxis in daily practice and the ACCP 2008 guidelines, in abdominal and pelvic cancer surgery. A better awareness of surgeons is probably the best guarantee for improvement of VTE prophylaxis in surgical wards.
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Affiliation(s)
- Negib Geahchan
- Faculty of Medicine, Saint Joseph University, Damascus street, Riad El Solh, P.O.Box 11-5076, Beirut, 1107 2180 Lebanon
| | - Melkart Basile
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Maroon Tohmeh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - on behalf of the DIONYS registry
- Faculty of Medicine, Saint Joseph University, Damascus street, Riad El Solh, P.O.Box 11-5076, Beirut, 1107 2180 Lebanon
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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18
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Van Hemelrijck M, Garmo H, Adolfsson J, Stattin P. Re: Adi J. Klil-Drori, Hui Yin, Vicky Tagalakis, Armen Aprikian, Laurent Azoulay. Androgen Deprivation Therapy for Prostate Cancer and Risk of Venous Thromboembolism. Eur Urol 2016;70:56-61. Eur Urol 2016; 71:e61-e62. [PMID: 27544579 DOI: 10.1016/j.eururo.2016.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Mieke Van Hemelrijck
- Cancer Epidemiology Group, Division of Cancer Studies, King's College, London, UK; Institue of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Hans Garmo
- Institue of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Regional Cancer Centre, Akademiska sjukhuset, Uppsala, Sweden
| | - Jan Adolfsson
- CLINTEC Department, Karolinska Institutet, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
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19
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Causes of hospital readmissions after urologic cancer surgery. Urol Oncol 2015; 34:236.e1-11. [PMID: 26712365 DOI: 10.1016/j.urolonc.2015.11.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 09/15/2015] [Accepted: 11/17/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The Hospital Readmissions Reduction Program mandates reimbursement reductions to hospitals with higher than expected rates of readmissions. We examine causes and predictors of readmissions following major procedures in urologic oncology. MATERIALS AND METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, patients undergoing radical prostatectomy (RP), radical (RN) or partial nephrectomy (PN), and radical cystectomy (RC) during the year 2012 were abstracted. Rates of unplanned readmission within 30 days after surgery, as well as causes of readmission, were identified. Multivariable logistic regression models were fitted to examine the association between patient perioperative factors and odds of readmission. RESULTS Overall, we observed a 5.5% unplanned 30-day readmission rate. Readmission rates for patients treated with RP, RN, PN, and RC were 4.1%, 5.2%, 4.5%, and 15.9%, respectively. For each procedure, approximately two-third of readmissions occurred within the first 10 days following hospital discharge. Commonest causes of readmission after RP included thromboembolic (13.6%), wound (12.2%), renal/genitourinary (12.2%), and gastrointestinal (11.8%); after RN, wound (12.9%) and gastrointestinal (12.9%); after PN, renal/genitourinary (19.6%), cardiovascular (9.8%), and bleeding/hematoma (9.8%); and after RC, renal/genitourinary (15.5%), wound (14.8%), and sepsis/infection (14.1%). RC was significantly associated with readmission. Patients undergoing open RP or PN were more likely to be readmitted relative to their minimally invasive counterparts (odds ratio = 1.53, 95% CI: 1.12-2.08, P = 0.007 and odds ratio = 2.51, 95% CI: 1.38-4.55, P = 0.003, respectively). CONCLUSIONS Readmissions are relatively common following major urologic oncology procedures. Compared with RP, RN, or PN, RC patients experience the highest burden of readmission. Venous thromboembolism is a common modifiable cause of readmission following urologic cancer surgery. Minimally invasive approach is associated with decreased odds of readmission following RP and PN.
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20
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O'Farrell S, Sandström K, Garmo H, Stattin P, Holmberg L, Adolfsson J, Van Hemelrijck M. Risk of thromboembolic disease in men with prostate cancer undergoing androgen deprivation therapy. BJU Int 2015; 118:391-8. [PMID: 26497726 DOI: 10.1111/bju.13360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) on androgen deprivation therapy (ADT), while accounting for known TED risk factors. MATERIALS AND METHODS We assessed TED risk for 42 263 men with PCa who were receiving ADT compared with a matched cohort of 190 930 without PCa. The associations between ADT and deep vein thrombosis (DVT) or pulmonary embolism (PE) were analysed using multivariate Cox proportional hazard regression models, while accounting for previous PCa-related surgeries and the following proxies for disease progression: transurethral resection of the prostate, palliative radiotherapy and nephrostomy. RESULTS Between 1997 and 2013, 11 242 men with PCa received anti-androgen monotherapy, 26 959 men received gonadotropin-releasing hormone (GnRH) agonists, 1 091 men received combined androgen blockade and 3 789 men underwent orchiectomy. When accounting for previous surgeries and proxies of disease progression, GnRH agonist users and surgically castrated men had a higher risk of TED than the comparison cohort: hazard ratios (HRs) 1.67 (95% confidence interval [CI] 1.40-1.98) and 1.61 (95% CI 1.15-2.28), respectively. Men on anti-androgen monotherapy had a lower risk: HR for DVT 0.49 (95% CI 0.33-0.74). TED risk was highest among those who switched from anti-androgen to GnRH agonists: HR for PE 2.55 (95% CI 1.76-3.70). This increased from 2.52 (95% CI 1.54-4.12) in year 1, to 4.05 (95% CI 2.51-6.55) in year 2. CONCLUSION The incidence of TED among men on ADT increased with the duration of therapy and the risk was highest for those who switched regimen, suggesting that disease progression as well as ADT contribute to the propagation of TED risk. Nonetheless, these findings support the hypothesis that only men with a relevant indication should receive systemic ADT.
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Affiliation(s)
- Sean O'Farrell
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK.,NIHR Guy's and St Thomas' NHS Foundation Trust, King's College London's Comprehensive Biomedical Research Centre, London, UK
| | - Karin Sandström
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK
| | - Hans Garmo
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK.,Regional Cancer Centre, Uppsala Örebro, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lars Holmberg
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK.,NIHR Guy's and St Thomas' NHS Foundation Trust, King's College London's Comprehensive Biomedical Research Centre, London, UK.,Regional Cancer Centre, Uppsala Örebro, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Swedish Council for Health Technology Assessment, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK.,NIHR Guy's and St Thomas' NHS Foundation Trust, King's College London's Comprehensive Biomedical Research Centre, London, UK.,Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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21
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Salomon L, Rozet F, Soulié M. La chirurgie du cancer de la prostate : principes techniques et complications péri-opératoires. Prog Urol 2015; 25:966-98. [DOI: 10.1016/j.purol.2015.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022]
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Mendhiratta N, Lee T, Prabhu V, Llukani E, Lepor H. 10-Year Mortality After Radical Prostatectomy for Localized Prostate Cancer in the Prostate-specific Antigen Screening Era. Urology 2015; 86:783-8. [DOI: 10.1016/j.urology.2015.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/14/2015] [Accepted: 05/22/2015] [Indexed: 11/24/2022]
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23
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Ording AG, Horváth-Puhó E, Lash TL, Ehrenstein V, Borre M, Vyberg M, Sørensen HT. Prostate cancer, comorbidity, and the risk of venous thromboembolism: A cohort study of 44,035 Danish prostate cancer patients, 1995-2011. Cancer 2015; 121:3692-9. [PMID: 26149752 DOI: 10.1002/cncr.29535] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/16/2015] [Accepted: 04/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a serious complication of cancer. It is unknown whether comorbidity interacts clinically with prostate cancer (PC) to increase the VTE rate beyond that explained by PC and comorbidity alone, for example, by delaying diagnosis or precluding treatment. METHODS A nationwide, registry-based cohort study of all 44,035 Danish patients diagnosed with PC from 1995 to 2011 and 213,810 men from the general population matched 5:1 on age, calendar time, and comorbidities. The authors calculated VTE rate ratios and the interaction contrast as a measure on the additive scale of the excess VTE rate explained by synergy between PC and comorbidity. RESULTS In total, 849 patients in the PC cohort and 2360 men from the general population had VTE during 5 years of follow-up, and their risk of VTE was 2.2% and 1.3%, respectively. The 1-year VTE standardized rate among PC patients who had high comorbidity levels was 15 per 1000 person-years (PYs) (95% confidence interval, 6.8-24 per 1000 PYs), and 29% of that rate was explained by an interaction between PC and comorbidity. The VTE risk was increased among older patients, those with metastases, those with high Gleason scores, those in the D'Amico high-risk group, and those who underwent surgery. CONCLUSIONS PC interacted clinically with high comorbidity levels and increased the VTE rate. Because of the large PC burden, reducing VTEs associated with comorbidities may have an impact on VTE risk and the potential to improve prognosis. Clinical interactions between high levels of comorbidity and PC on the risk of VTE were observed. Almost 30% of all episodes of VTE occurred among patients who had high levels of comorbidity.
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Affiliation(s)
- Anne G Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Mogens Vyberg
- Institute of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Abusanad OZ, Floyd MS, Johnson EU, McHugh J, McCabe JE. Haematological considerations in urology: A systematic review. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815577314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Deep venous thrombosis (DVT) remains a serious and common complication of surgical procedures and is therefore an issue of importance for all urologists. In the UK, pulmonary embolism (PE) following DVT in hospitalised patients causes 32,000 deaths each year. DVT and PE represent the outcome of venous thromboembolism (VTE). The total cost for management of VTE in 2005 was approximately ₤640 million. Early risk assessment and optimising modifiable risks are paramount in order to reduce the incidence of VTE. In this article we review common risk factors for VTE and emphasise specific risk factors for urological procedures. The perioperative management of urological patients who are chronically anticoagulated is discussed. We review the literature regarding anticoagulation and its relevance to all urological procedures and mention the problems associated with new anticoagulant agents. All urologists should be familiar with the new range of anticoagulant agents due to the increasing number of patients taking them.
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Affiliation(s)
- OZ Abusanad
- Department of Urology, Whiston Hospital, St Helens & Knowsley Teaching Hospitals NHS Trust, UK
| | - MS Floyd
- Department of Urology, Whiston Hospital, St Helens & Knowsley Teaching Hospitals NHS Trust, UK
| | - EU Johnson
- Department of Urology, Whiston Hospital, St Helens & Knowsley Teaching Hospitals NHS Trust, UK
| | - J McHugh
- Department of Haematology, Tallaght Hospital, Republic of Ireland
| | - JE McCabe
- Department of Urology, Whiston Hospital, St Helens & Knowsley Teaching Hospitals NHS Trust, UK
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Kjölhede H, Bratt O, Gudjonsson S, Sundqvist P, Liedberg F. Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer. Scand J Urol 2014; 49:97-102. [DOI: 10.3109/21681805.2014.968867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Tyritzis SI, Wallerstedt A, Steineck G, Nyberg T, Hugosson J, Bjartell A, Wilderäng U, Thorsteinsdottir T, Carlsson S, Stranne J, Haglind E, Wiklund NP. Thromboembolic complications in 3,544 patients undergoing radical prostatectomy with or without lymph node dissection. J Urol 2014; 193:117-25. [PMID: 25158271 DOI: 10.1016/j.juro.2014.08.091] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE Lymph node dissection in patients with prostate cancer may increase complications. An association of lymph node dissection with thromboembolic events was suggested. We compared the incidence and investigated predictors of deep venous thrombosis and pulmonary embolism among other complications in patients who did or did not undergo lymph node dissection during open and robot-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS Included in study were 3,544 patients between 2008 and 2011. The cohort was derived from LAPPRO, a multicenter, prospective, controlled trial. Data on adverse events were extracted from patient completed questionnaires. Our primary study outcome was the prevalence of deep venous thrombosis and/or pulmonary embolism. Secondary outcomes were other types of 90-day adverse events and causes of hospital readmission. RESULTS Lymph node dissection was performed in 547 patients (15.4%). It was associated with eightfold and sixfold greater risk of deep venous thrombosis and pulmonary embolism events compared to that in patients without lymph node dissection (RR 7.80, 95% CI 3.51-17.32 and 6.29, 95% CI 2.11-18.73, respectively). Factors predictive of thromboembolic events included a history of thrombosis, pT4 stage and Gleason score 8 or greater. Open radical prostatectomy and lymph node dissection carried a higher risk of deep venous thrombosis and/or pulmonary embolism than robot-assisted laparoscopic radical prostatectomy (RR 12.67, 95% CI 5.05-31.77 vs 7.52, 95% CI 2.84-19.88). In patients without lymph node dissection open radical prostatectomy increased the thromboembolic risk 3.8-fold (95% CI 1.42-9.99) compared to robot-assisted laparoscopic radical prostatectomy. Lymph node dissection induced more wound, respiratory, cardiovascular and neuromusculoskeletal events. It also caused more readmissions than no lymph node dissection (14.6% vs 6.3%). CONCLUSIONS Among other adverse events we found that lymph node dissection during radical prostatectomy increased the incidence of deep venous thrombosis and pulmonary embolism. Open surgery increased the risks more than robot-assisted surgery. This was most prominent in patients who were not treated with lymph node dissection.
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Affiliation(s)
- Stavros I Tyritzis
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Minimally Invasive Urological Surgery, Athens Medical Center, Athens, Greece.
| | - Anna Wallerstedt
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tommy Nyberg
- Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Oncology, Lund University, Lund, Sweden
| | - Ulrica Wilderäng
- Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Thordis Thorsteinsdottir
- Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Stefan Carlsson
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Nils Peter Wiklund
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Alberts BD, Woldu SL, Weinberg AC, Danzig MR, Korets R, Badani KK. Venous thromboembolism after major urologic oncology surgery: a focus on the incidence and timing of thromboembolic events after 27,455 operations. Urology 2014; 84:799-806. [PMID: 25156513 DOI: 10.1016/j.urology.2014.05.055] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/28/2014] [Accepted: 05/16/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the incidence and timing of venous thromboembolism (VTE) and identify risk factors for venous thromboembolism among patients undergoing major surgery for urologic malignancies. VTE events are stratified by occurrence in the inpatient vs outpatient settings. MATERIALS AND METHODS The National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Statistical Classification of Diseases, Ninth Revision codes to identify patients undergoing major surgery for urologic malignancies between 2005 and 2012. The incidence of overall 30-day VTE, postdischarge VTE, and post-VTE death was calculated for each surgical procedure. Logistic regression analysis was used to identify risk factors for VTE, adjusting for covariates including age, race, gender, smoking status, medical comorbidities, performance of pelvic lymph node dissection, and operative time. RESULTS The study identified 27,455 patients who underwent an operation for malignancy--radical nephrectomy, partial nephrectomy, nephroureterectomy, radical prostatectomy, or radical cystectomy. The incidence and timing of VTE varied substantially across the procedures of interest. Overall, VTE occurred after radical cystectomy in 113 of 2065 of patients (5.5%), whereas only 19 of 2624 (0.7%) and 12 of 1690, respectively, of patients undergoing minimally invasive radical or partial nephrectomy procedures suffered a VTE event within 30-days of surgery. Among patients suffering a VTE after radical prostatectomy, 147 of 178 of venous thromboembolic events (82.6%) occurred after hospital discharge. CONCLUSION This study demonstrates the significant burden of VTE beyond the time of hospital discharge. Identification of high-risk patients should prompt consideration of extended-duration VTE prophylaxis in the outpatient setting.
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Affiliation(s)
- Blake D Alberts
- Department of Urology, Columbia University Medical Center, New York, NY.
| | - Solomon L Woldu
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Aaron C Weinberg
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Matthew R Danzig
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Ruslan Korets
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Ketan K Badani
- Department of Urology, Columbia University Medical Center, New York, NY
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Sofra M, Antenucci A, Gallucci M, Mandoj C, Papalia R, Claroni C, Monteferrante I, Torregiani G, Gianaroli V, Sperduti I, Tomao L, Forastiere E. Perioperative changes in pro and anticoagulant factors in prostate cancer patients undergoing laparoscopic and robotic radical prostatectomy with different anaesthetic techniques. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2014; 33:63. [PMID: 25129475 PMCID: PMC4431486 DOI: 10.1186/s13046-014-0063-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/15/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic prostatectomy (LRP) may activate clotting system influencing the risk of perioperative thrombosis in patients with prostate cancer. Moreover, different anaesthetic techniques can also modify coagulant factors. Thus, the aim of this study was to investigate the effects on pro- and anti-coagulant and fibrinolytic factors of two established types of anaesthesia in patients with prostate cancer undergoing elective LRP. METHODS 102 patients with primary prostate cancer, who underwent conventional LRP or robot-assisted laparoscopic prostatectomy (RALP), were studied and divided into 2 groups to receive total intravenous anesthesia with target-controlled infusion (TIVA-TCI) or balanced inhalation anaesthesia (BAL) prior to surgery. Before the induction of anaesthesia (T0), 1 hr (T1) and 24 hrs post-surgery (T2), some pro-coagulant factors, fibronolysis markers, p-selectin and haemostatic system inhibitors were evaluated. RESULTS Both TIVA-TCI and BAL patients showed a marked and significant increase in pro-coagulant factors and consequent reduction in haemostatic system inhibitors in the early post operative period (p ≤ 0.004 for each markers). Use of RALP showed a significant increase in prothrombotic markers as compared to LRP. In TIVA patients undergoing LRP, a significant reduction of p-selectin levels between T0 and T2 (p = 0.001) was observed as compared to BAL, suggesting a better protective effect on platelet activation of anaesthetic agents used for TIVA. CONCLUSIONS Both anaesthetic techniques significantly seem to increase the risk of thrombosis in prostate cancer patients undergoing LRP, mainly when the robotic device was utilized, encouraging the use of a peri-operative thromboembolic prophylaxis in these patients.
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Affiliation(s)
- Maria Sofra
- Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy.
| | - Anna Antenucci
- Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy.
| | - Michele Gallucci
- Department of Urology, Regina Elena, Roma National Cancer Institute, Rome, Italy.
| | - Chiara Mandoj
- Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy.
| | - Rocco Papalia
- Department of Urology, Regina Elena, Roma National Cancer Institute, Rome, Italy.
| | - Claudia Claroni
- Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy.
| | - Ilaria Monteferrante
- Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy.
| | - Giulia Torregiani
- Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy.
| | - Valeria Gianaroli
- Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy.
| | - Isabella Sperduti
- Division of Biostatistic, Regina Elena, Roma National Cancer Institute, Rome, Italy.
| | - Luigi Tomao
- Clinical Pathology, Regina Elena, Roma National Cancer Institute, Rome, Italy.
| | - Ester Forastiere
- Department of Anaesthesiology, Regina Elena, Roma National Cancer Institute, Via Elio Chianesi 53, Roma, 00144, Italy.
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Saar M, Ohlmann CH, Janssen M, Stöckle M, Siemer S. [Radical prostatectomy. Detection and management of intra- and postoperative complications]. Urologe A 2014; 53:976-83. [PMID: 25023234 DOI: 10.1007/s00120-014-3500-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Radical prostatectomy is the most common treatment for organ-confined prostate cancer. Performed without complications and limitations, surgery will allow complete removal of the tumor and, therefore, cure the patient. Operative techniques have been improved during the last few decades to reduce invasiveness of the procedure. Furthermore, optimized perioperative management has shortened hospital stay. To ensure rapid recovery of each patient, early detection of complications is highly relevant. Herein, different scenarios for peri- and postoperative complications are described, and recommendations for best practice solutions are reviewed.
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Affiliation(s)
- M Saar
- Klink für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 1, Geb. 6, 66421, Homburg/Saar, Deutschland,
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Tyson MD, Castle EP, Humphreys MR, Andrews PE. Venous thromboembolism after urological surgery. J Urol 2014; 192:793-7. [PMID: 24594402 DOI: 10.1016/j.juro.2014.02.092] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE We determined the rates of deep venous thromboembolism and pulmonary embolism after common urological procedures in the United States. MATERIALS AND METHODS The NSQIP database was used to identify common urological procedures performed between January 1, 2005 and December 31, 2011. A total of 82,808 patients were included in the study. RESULTS Overall 633 (0.76% of 82,808 subjects) deep venous thromboses occurred within 30 days of surgery in this cohort of patients treated with common urological procedures. Among procedures performed at least 500 times the rates of deep venous thrombosis were highest for cystectomy/urinary diversion (3.96% [71/1,792]), partial cystectomy (2.35% [17/722]) and open radical nephrectomy (1.67% [45/2,702]). The rates of deep venous thrombosis were lowest in patients undergoing laparoscopic colpopexy (0.00% [0/707]), placement of a female sling (0.08% [9/10,648]) and hydrocelectomy/spermatocelectomy/varicocelectomy (0.13% [3/2,333]). A total of 349 (0.42%) pulmonary embolisms occurred in this cohort, with cystectomy/urinary diversion having the highest rate overall (2.85% [51/1,792]). Multivariate logistic regression revealed that age greater than 60 years, functional status, history of disseminated cancer, congestive heart failure, anesthesia time greater than 120 minutes and chronic steroid use were independently associated with the formation of deep venous thrombosis/pulmonary embolism. A limitation of the study is that no data were available on thromboembolic prophylaxis. CONCLUSIONS While deep venous thrombosis and pulmonary embolism are uncommon after urological surgery, this study is the first to our knowledge to provide a comprehensive comparison of deep venous thrombosis/pulmonary embolism rates across a full spectrum of various urological procedures in American patients. This study should give the reader a better understanding of the exact risk faced by the patient when undergoing common urological procedures.
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Affiliation(s)
- Mark D Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona.
| | - Erik P Castle
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona
| | | | - Paul E Andrews
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona
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31
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Tollefson MK, Karnes RJ, Rangel L, Carlson R, Boorjian SA. Blood Type, Lymphadenectomy and Blood Transfusion Predict Venous Thromboembolic Events Following Radical Prostatectomy with Pelvic Lymphadenectomy. J Urol 2014; 191:646-51. [DOI: 10.1016/j.juro.2013.10.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Matthew K. Tollefson
- Departments of Urology and Health Sciences Research (LR, RC), Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - R. Jeffrey Karnes
- Departments of Urology and Health Sciences Research (LR, RC), Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Laureano Rangel
- Departments of Urology and Health Sciences Research (LR, RC), Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Rachel Carlson
- Departments of Urology and Health Sciences Research (LR, RC), Mayo Medical School and Mayo Clinic, Rochester, Minnesota
| | - Stephen A. Boorjian
- Departments of Urology and Health Sciences Research (LR, RC), Mayo Medical School and Mayo Clinic, Rochester, Minnesota
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Husson O, van Steenbergen LN, Koldewijn EL, Poortmans PM, Coebergh JWW, Janssen-Heijnen ML. Patients with prostate cancer continue to have excess mortality up to 15 years after diagnosis. BJU Int 2014; 114:691-7. [DOI: 10.1111/bju.12519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Olga Husson
- Eindhoven Cancer Registry; Comprehensive Cancer Centre South; Eindhoven The Netherlands
- Centre for Research on Psychology in Somatic Diseases; Tilburg University; Tilburg The Netherlands
| | | | | | - Philip M. Poortmans
- Department of Radiation Oncology; Institute Verbeeten; Tilburg The Netherlands
| | - Jan Willem W. Coebergh
- Eindhoven Cancer Registry; Comprehensive Cancer Centre South; Eindhoven The Netherlands
- Department of Public Health; Erasmus University Medical Centre; Rotterdam The Netherlands
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Takakura A, Stewart PJ, Johnson RN, Cunningham ET. Purtscher-like retinopathy after prostate surgery. Retin Cases Brief Rep 2014; 8:245-246. [PMID: 25372518 DOI: 10.1097/icb.0000000000000111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To describe a case of Purtscher-like retinopathy after uncomplicated radical prostatectomy. METHODS Observational case report. RESULTS Purtscher retinopathy is named after the Austrian ophthalmologist Othmar Purtscher (1852-1927) who first fully described the syndrome of "traumatic retinal angiopathy" in 1912 as patches of retinal whitening, retinal hemorrhages, and disk edema after compression injury to the head. Since that time, similar findings, often called Purtscher-like retinopathy, have been described in association with a number of conditions, including, among others, acute pancreatitis, chest compression injury, childbirth, and fat embolism syndrome, after long-bone fracture or surgery. CONCLUSION The occurrence of Purtscher-like changes after nonorthopedic surgery seems, however, to be rare. The authors describe a single case of Purtscher-like retinopathy after uncomplicated radical prostatectomy.
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Affiliation(s)
- Ako Takakura
- *Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; †West Coast Retina Medical Group, San Francisco, California; and ‡Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
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Säily VMJ, Pétas A, Joutsi-Korhonen L, Taari K, Lassila R, Rannikko AS. Dabigatran for thromboprophylaxis after robotic assisted laparoscopic prostatectomy: Retrospective analysis of safety profile and effect on blood coagulation. Scand J Urol 2013; 48:153-9. [DOI: 10.3109/21681805.2013.817482] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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35
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Ball MW, Gorin MA, Allaf ME. Reducing morbidity of pelvic and retroperitoneal lymphadenectomy. Curr Urol Rep 2013; 14:488-95. [PMID: 23765446 DOI: 10.1007/s11934-013-0350-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lymphadenectomy is utilized in both pelvic and retroperitoneal oncological surgery as a means to eradicate locoregional disease, improve staging accuracy and guide adjuvant therapy. However, pelvic and retroperitoneal lymphadenectomy have the potential for morbidity including lymphatic injury, vascular injury, thromboembolic events and neurologic injury. Across the spectrum of urologic malignancies, the evidence supporting both the necessity and the extent of lymphadenectomy varies considerably. Awareness of the potential for injury and ways to avoid and manage the most common complications is necessary to decrease the morbidity associated with these procedures.
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Affiliation(s)
- Mark W Ball
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, 1800 Orleans St, Baltimore, MD, 21287, USA,
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