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The association of lymph node dissection with 30-day perioperative morbidity among men undergoing minimally invasive radical prostatectomy: analysis of the National Surgical Quality Improvement Program (NSQIP)

Prostate Cancer and Prostatic Diseases volume 21, pages 245–251 (2018)Cite this article

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Abstract

Background:

The incremental morbidity of lymph node dissection (LND) among men undergoing radical prostatectomy remains uncertain. We therefore evaluated  the association of LND with perioperative morbidity among men undergoing minimally invasive radical prostatectomy (MIRP).

Methods:

We identified 29,012 men aged 35–89 who underwent MIRP from 2010–2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 47% underwent concomitant LND. The associations of LND with 30-day perioperative morbidity and mortality were evaluated using logistic regression, adjusted for patient features.

Results:

Median age at surgery was 63 (IQR 57, 67) years. There were statistically significant, but clinically insignificant, differences in several baseline characteristics stratified by performance of LND, including older age at surgery (p < 0.001), higher American Society of Anesthesiology (ASA) class (p < 0.001), and longer operative time (p < 0.001) for men who underwent LND. Overall, 30-day complications occurred in 4.3% of patients. There were no statistically significant differences in rates of 30-day complications (4.2 vs. 4.4%, p = 0.44), perioperative blood transfusion (1.7 vs. 1.7%, p = 0.99), hospital readmission (3.6 vs. 4.0%, p = 0.09), reoperation (1.1 vs. 1.1%, p = 0.80), or 30-day mortality (0.1 vs. 0.2%, p = 0.56) between patients who underwent MIRP alone or MIRP with LND, respectively. On multivariable analysis, LND was not significantly associated with an increased risk of perioperative morbidity or 30-day mortality.

Conclusions:

LND at the time of MIRP does not appear to be associated with an increased risk of perioperative morbidity.

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Acknowledgements

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Warren Alpert Medical School of Brown University, Providence, RI, USA

    Joseph Brito III, Jorge Pereira, Gyan Pareek, Joseph Renzulli II, Dragan Golijanin & Boris Gershman

  2. Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA

    Joseph Brito III, Jorge Pereira, Gyan Pareek, Joseph Renzulli II, Dragan Golijanin & Boris Gershman

  3. Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA

    Jorge Pereira, Gyan Pareek, Christopher Tucci, Joseph Renzulli II, Dragan Golijanin & Boris Gershman

  4. Department of Urology, University of Illinois, Chicago, Illinois, USA

    Daniel M. Moreira

  5. Department of Biostatistics, Brown University, Providence, RI, USA

    Ruiting Guo & Zheng Zhang

  6. Department of Pathology & Laboratory Medicine, The Miriam Hospital, Providence, RI, USA

    Ali Amin

  7. Department of Hematology/Oncology, The Miriam Hospital, Providence, RI, USA

    Anthony Mega

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Correspondence to Boris Gershman.

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Brito, J., Pereira, J., Moreira, D.M. et al. The association of lymph node dissection with 30-day perioperative morbidity among men undergoing minimally invasive radical prostatectomy: analysis of the National Surgical Quality Improvement Program (NSQIP). Prostate Cancer Prostatic Dis 21, 245–251 (2018). https://doi.org/10.1038/s41391-018-0051-z

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