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Extended pelvic lymph node dissection in robot-assisted radical prostatectomy is an independent risk factor for major complications

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Abstract

The aim of this study is to evaluate the major postoperative complication rate after robot-assisted radical prostatectomy (RARP) and to identify related risk factors. A consecutive series of patients who underwent RARP between September 2016 and May 2021, with or without extended pelvic lymph node dissection (ePLND) were analyzed for postoperative complications that occurred within 30 days following surgery. Potential risk factors related to complications were identified by means of a multivariate logistic analysis. Electronic medical records were retrospectively reviewed for the occurrence of major complications (Clavien–Dindo grade III or higher) on a per patient level. A multivariate logistic regression with risk factors was performed to identify contributors to complications. In total, 1280 patients were included, of whom 79 (6.2%) experienced at least 1 major complication. Concomitant ePLND was performed in 609 (48%) of patients. The majority of all complications were likely related to the surgical procedure, with anastomotic leakage and lymphoceles being the most common. Upon multivariate analysis, performing ePLND remained the only significant risk factor for the occurrence of major complications (OR 2.26, p = 0.001). In contrast to robot-assisted radical prostatectomy alone, the combination with extended pelvic lymph node dissection (ePLND) has a substantial risk of serious complications. Since the ePLND is performed mainly for staging purpose, the clinical contribution of the ePLND has to be reconsidered with the present use of the PSMA-PET/CT.

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Acknowledgements

We acknowledge A. Azam, A. Feikema, and N. de Kort for their assistance with the data collection.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Urology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands

    Diederik J. H. Baas, Joost M. S. de Baaij, Diederik M. Somford & Jean-Paul A. van Basten

  2. Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands

    Diederik J. H. Baas, Joost M. S. de Baaij, J. P. Michiel Sedelaar, Robert J. Hoekstra, Henricus J. E. J. Vrijhof, Diederik M. Somford & Jean-Paul A. van Basten

  3. Department of Urology, Radboud UMC, Nijmegen, The Netherlands

    J. P. Michiel Sedelaar

  4. Department of Urology, Catharina Hospital, Eindhoven, The Netherlands

    Robert J. Hoekstra & Henricus J. E. J. Vrijhof

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  1. Diederik J. H. Baas
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  2. Joost M. S. de Baaij
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Contributions

All authors contributed to the study conception and design. Material preparation and analysis were performed by DB. Data collection was performed by JB and DB. The first draft of the manuscript was written by DB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Diederik J. H. Baas.

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Ethics approval

The Medical Ethics Review Committee (CMO Arnhem-Nijmegen, registration number: 003-2020) confirmed that the Medical Research Involving Human Subjects Act does not apply to this study and the local ethics committee approved this study. Informed consent was not required because of the retrospective nature of this study.

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Baas, D.J.H., de Baaij, J.M.S., Sedelaar, J.P.M. et al. Extended pelvic lymph node dissection in robot-assisted radical prostatectomy is an independent risk factor for major complications. J Robotic Surg 18, 140 (2024). https://doi.org/10.1007/s11701-024-01881-2

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