|
|
|
| Transurethral prostate surgery in prostate cancer patients: A population-based comparative analysis of complication and mortality rates |
Michele Marchionia,b,*( ),Giulia Primicerib,Alessandro Vecciac,Marta Di Nicolaa,Umberto Carbonarac,Fabio Crocerossac,Ugo Falagarioc,Ambra Rizzolib,Riccardo Autorinoc,Luigi Schipsb
|
aLaboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
bUrology Unit, Department of Medical, Oral and Biotechnological Sciences, “G. d'Annunzio” University of Chieti, Chieti, Italy
cDivision of Urology, VCU Health, Richmond, VA, USA |
|
|
|
|
Abstract Objective: Prostate cancer (PCa) patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia (BPH). Some of them might be treated for their lower urinary tract symptoms instead of PCa. We aimed to test the effect of PCa versus BPH on surgical outcomes after transurethral prostate surgery, namely complication and mortality rates. Methods: Within the American College of Surgeons National Surgical Quality Improvement Program database (2011-2016), we identified patients who underwent transurethral resection of the prostate, photoselective vaporization, or laser enucleation. Patients were stratified according to postoperative diagnosis (PCa vs. BPH). Univariable and multivariable logistic regression models evaluated the predictors of perioperative morbidity and mortality. A formal test of interaction between diagnosis and surgical technique used was performed. Results: Overall, 34 542 patients were included. Of all, 2008 (5.8%) had a diagnosis of PCa. The multivariable logistic regression model failed to show statistically significant higher rates of postoperative complications in PCa patients (odds ratio: 0.9, 95% confidence interval: 0.7-1.1; p=0.252). Moreover, similar rates of perioperative mortality (p=0.255), major acute cardiovascular events (p=0.581), transfusions (p=0.933), and length of stay of more than or equal to 30 days (p=0.174) were found. Additionally, all tests failed to show an interaction between post-operative diagnosis and surgical technique used. Conclusion: Patients diagnosed with PCa do not experience higher perioperative morbidity or mortality after transurethral prostate surgery when compared to their BPH counterparts. Moreover, the diagnosis seems to not influence surgical technique outcomes.
|
|
Received: 29 September 2021
Available online: 20 January 2024
|
|
Corresponding Authors:
*Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio University of Chieti, Chieti, Italy. E-mail address: mic.marchioni@gmail.com (M. Marchioni).
|
|
|
| Feature, n (%) | BPH (n=32 534) | PCa (n=2008) | p-Valuea | | Surgical procedure | | | <0.001 | | TURP | 20 408 (62.7) | 1574 (78.4) | | | PVP | 10 326 (31.7) | 231 (11.5) | | | Enucleation | 1800 (5.5) | 203 (10.1) | | | Age (>75 years) | 10 645 (32.7) | 901 (44.9) | <0.001 | | Year of surgery | | | 0.360 | | 2011-2013 | 11 082 (34.1) | 704 (35.1) | | | 2014-2016 | 21 452 (65.9) | 1304 (64.9) | | | Race | | | <0.001 | | Caucasian | 22 612 (69.5) | 1356 (67.5) | | | African-American | 1710 (5.3) | 184 (9.2) | | | Other | 7057 (21.7) | 389 (19.4) | | | Unknown | 1155 (3.6) | 79 (3.9) | | | BMI, kg/m2 | | | 0.968 | | Normal | 8166 (25.1) | 507 (25.2) | | | Underweight | 261 (0.8) | 16 (0.8) | | | Overweight | 13 613 (41.8) | 841 (41.9) | | | Obese | 10 292 (31.6) | 629 (31.3) | | | Unknown | 202 (0.6) | 15 (0.7) | | | Functional status | | | 0.505 | | Independent | 31 460 (96.7) | 1946 (96.9) | | | Partially dependent | 686 (2.1) | 45 (2.2) | | | Totally dependent | 70 (0.2) | 4 (0.2) | | | Unknown | 318 (1.0) | 13 (0.6) | | | Smoking history | 3343 (10.3) | 241 (12.0) | 0.014 | | Diabetes | | | 0.560 | | No | 25 743 (79.1) | 1569 (78.1) | | | Insulin dependent | 1949 (6.0) | 124 (6.2) | | | Non-insulin dependent | 4842 (14.9) | 315 (15.7) | | | Hypertension | 19 532 (60.0) | 1253 (62.4) | 0.036 | | Respiratory disorders | 3373 (10.4) | 234 (11.7) | 0.067 | | Recent congestive heart failure | 237 (0.7) | 11 (0.5) | 0.352 | | Chronic steroid use | 745 (2.3) | 73 (3.6) | <0.001 | | Weight loss (>10%) | 135 (0.4) | 10 (0.5) | 0.576 | | Bleeding disorders | 1022 (3.1) | 49 (2.4) | 0.079 | | Preoperative transfusions | 27 (0.1) | 6 (0.3) | 0.002 | | SIRS or sepsis | 72 (0.2) | 5 (0.2) | 0.798 | | Renal disorders | 172 (0.5) | 17 (0.8) | 0.061 | | ASA score >2 | 16 289 (50.1) | 1177 (58.6) | <0.001 | | Anesthesia | | | 0.947 | | General | 25 335 (77.9) | 1560 (77.7) | | | Locoregional | 6529 (20.1) | 408 (20.3) | | | Others | 670 (2.1) | 40 (2.0) | | | Inpatients status | 10 357 (31.8) | 806 (40.1) | <0.001 | | Operation time, min | | | <0.001 | | ≤90 | 27 765 (85.3) | 1657 (82.5) | | | >90 | 4769 (14.7) | 351 (17.5) | |
|
|
Descriptive pre- and intra-operative characteristics of patients undergoing transurethral surgery of the prostate stratified according to diagnosis (BPH vs. PCa).
|
| Outcome | BPH (n=32 534) | PCa (n=2008) | p-Valuea | | Length of stayb, day | 1.1±3.5 | 1.4±3.0 | <0.001c | | Postoperative pneumoniad | 71 (0.2) | 4 (0.2) | 0.859 | | Intubationd | 55 (0.2) | 2 (0.1) | 0.457 | | Acute renal failured | 28 (0.1) | 3 (0.1) | 0.358 | | Urinary tract infectiond | 1499 (4.6) | 78 (3.9) | 0.132 | | Intra- and post-operative transfusionsd | 269 (0.8) | 26 (1.3) | 0.027 | | Sepsisd | 221 (0.7) | 8 (0.4) | 0.132 | | Septic shockd | 48 (0.1) | 2 (0.1) | 0.583 | | Reoperationd | 568 (1.7) | 30 (1.5) | 0.401 | | Readmissiond | 1624 (5.0) | 110 (5.5) | 0.333 | | Unplanned | 1429 (4.4) | 90 (4.5) | 0.849 | | Related to the procedure | 1136 (3.5) | 75 (3.7) | 0.565 | | Deathd | 71 (0.2) | 3 (0.1) | 0.517 |
|
|
Descriptive post-operative outcomes and complications in patients who underwent transurethral surgery of the prostate stratified according to diagnosis (BPH vs. PCa).
|
| Outcome of interest | Events, n (%) | Multivariable logistic regression model (BPH as reference) | | BPH (n=32 534) | PCa (n=2008) | OR (95% CI) | p-Value | | Primary outcome | | | Postoperative complications | 2076 (6.4) | 124 (6.2) | 0.9 (0.7-1.1) | 0.252 | | Secondary outcome | | | | | | Perioperative mortality | 71 (0.2) | 3 (0.1) | 0.5 (0.1-1.4) | 0.255 | | Major acute cardiovascular event | 207 (0.6) | 17 (0.8) | 1.2 (0.7-1.8) | 0.581 | | Transfusion | 269 (0.8) | 26 (1.3) | 1.0 (0.7-1.5) | 0.933 | | Length of stay ≥30 days | 63 (0.2) | 8 (0.4) | 1.7 (0.7-3.3) | 0.174 |
|
|
Multivariable logistic regression model comparing event rates between BPH and PCa patients.
|
| [1] |
Gravas S, Cornu JN, Gacci M, Gratzke C, Hermann TRW, Mamoulakis C, et al. EAU guidelines on management of nonneurogenic male LUTS. Uroweb; 2022. https://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/. [Accessed 16 August 2022].
|
| [2] |
Gondran-Tellier B, McManus R, Sichez PC, Akiki A, Gaillet S, Toledano H, et al. Efficacy and safety of surgery for benign prostatic obstruction in patients with preoperative urinary catheter. J Endourol 2021; 35:102-8.
doi: 10.1089/end.2020.0704
|
| [3] |
Desai MM, Cacciamani GE, Gill K, Zhang J, Liu L, Abreu A, et al. Trends in incidence of metastatic prostate cancer in the US. JAMA Netw Open 2022; 5:e222246. https://doi.org/10.1001/jamanetworkopen.2022.2246.
|
| [4] |
Banerji JS, Wolff EM, Massman JD, Odem-Davis K, Porter CR, Corman JM. Prostate needle biopsy outcomes in the era of the U.S. Preventive Services Task Force recommendation against prostate specific antigen based screening. J Urol 2016; 195:66-73.
doi: 10.1016/j.juro.2015.07.099
pmid: 26254722
|
| [5] |
Capogrosso P, Capitanio U, Vertosick EA, Ventimiglia E, Chierigo F, Oreggia D, et al. Temporal trend in incidental prostate cancer detection at surgery for benign prostatic hyperplasia. Urology 2018; 122:152-7.
doi: S0090-4295(18)30783-0
pmid: 30138683
|
| [6] |
Porcaro AB, Tafuri A, Inverardi D, Amigoni N, Sebben M, Pirozzi M, et al. Incidental prostate cancer after transurethral resection of the prostate: analysis of incidence and risk factors in 458 patients. Minerva Urol Nefrol 2021; 73:471-80.
|
| [7] |
Mahal BA, Butler S, Franco I, Spratt DE, Rebbeck TR, D’Amico AV, et al. Use of active surveillance or watchful waiting for low-risk prostate cancer and management trends across risk groups in the United States, 2010—2015. JAMA 2019; 321:704-6.
doi: 10.1001/jama.2018.19941
|
| [8] |
Shevach J, Weiner A, Morgans AK. Quality of lifeefocused decision-making for prostate cancer. Curr Urol Rep 2019; 20:57. https://doi.org/10.1007/s11934-019-0924-2.
doi: 10.1007/s11934-019-0924-2
|
| [9] |
Pompe RS, Tilki D, Preisser F, Leyh-Bannurah S-R, Bandini M, Marchioni M, et al. Survival benefit of local versus no local treatment for metastatic prostate cancerdImpact of baseline PSA and metastatic substages. Prostate 2018; 78:753-7.
doi: 10.1002/pros.v78.10
|
| [10] |
Tan YG, Pang L, Khalid F, Poon R, Huang HH, Chen K, et al. Local and systemic morbidities of de novo metastatic prostate cancer in Singapore: insight from 685 consecutive patients from a large prospective Uro-oncology registry. BMJ Open 2020; 10:e034331. https://doi.org/10.1136/bmjopen-2019-034331.
doi: 10.1136/bmjopen-2019-034331
|
| [11] |
Marchioni M, Cindolo L, Di Nicola M, Schips L, De Sio M, Lima E, et al. Major acute cardiovascular events after transurethral prostate surgery: a population-based analysis. Urology 2019; 131:196-203.
doi: S0090-4295(19)30457-1
pmid: 31145946
|
| [12] |
Petersen LJ. Anticoagulation therapy for prevention and treatment of venous thromboembolic events in cancer patients: a review of current guidelines. Cancer Treat Rev 2009; 35:754-64.
doi: 10.1016/j.ctrv.2009.08.009
pmid: 19762155
|
| [13] |
Quintana RA, Monlezun DJ, Davogustto G, Saenz HR, Lozano-Ruiz F, Sueta D, et al. Outcomes following percutaneous coronary intervention in patients with cancer. Int J Cardiol 2020; 300:106-12.
doi: S0167-5273(19)32714-7
pmid: 31611091
|
| [14] |
Klaassen Z, Wallis CJD, Lavallée LT, Violette PD. Perioperative venous thromboembolism prophylaxis in prostate cancer surgery. World J Urol 2020; 38:593-600.
doi: 10.1007/s00345-019-02705-x
pmid: 30840115
|
| [15] |
De Nunzio C, Lombardo R, Autorino R, Cicione A, Cindolo L, Damiano R, et al. Contemporary monopolar and bipolar transurethral resection of the prostate: prospective assessment of complications using the Clavien system. Int Urol Nephrol 2013; 45:951-9.
doi: 10.1007/s11255-013-0476-1
pmid: 23722819
|
| [16] |
Cavanaugh JE, Neath AA. The Akaike information criterion: background, derivation, properties, application, interpretation, and refinements. WIREs Computational Statistics 2019; 11:e1460. https://doi.org/10.1002/wics.1460.
|
| [17] |
Jibara G, Sjoberg DD, Stearns GL, Stabholz Y, Fathollahi A, Leddy LS, et al. Photoselective vaporization of the prostate in the management of lower urinary tract symptoms in prostate cancer patients on active surveillance. Urology 2021; 156:225-30.
doi: 10.1016/j.urology.2021.01.040
pmid: 33539897
|
| [18] |
Choi SY, Ryu J, You D, Jeong IG, Hong JH, Ahn H, et al. Oncological effect of palliative transurethral resection of the prostate in patients with advanced prostate cancer: a propensity score matching study. J Cancer Res Clin Oncol 2018; 144:751-8.
doi: 10.1007/s00432-018-2597-5
pmid: 29417257
|
| [19] |
Pelletier J, Cyr SJ, Julien AS, Fradet Y, Lacombe L, Toren P. Contemporary outcomes of palliative transurethral resection of the prostate in patients with locally advanced prostate cancer. Urol Oncol 2018; 36:363.e7-11.https://doi.org/10.1016/j.urolonc.2018.05.004.
doi: 10.1016/j.urolonc.2018.05.004
|
| [20] |
Kumar N, Vasudeva P, Kumar A, Singh H, Sinha A. A prospective comparative study of channel photoselective vaporization of the prostate vs. channel transurethral resection of the prostate in patients with advanced prostate carcinoma. Minerva Urol Nefrol 2016; 68:330-6.
pmid: 27404375
|
| [21] |
Campobasso D, Marchioni M, Altieri V, Greco F, De Nunzio C, Destefanis P, et al. GreenLight photoselective vaporization of the prostate: one laser for different prostate sizes. J Endourol 2020; 34:54-62.
doi: 10.1089/end.2019.0478
pmid: 31617419
|
| [22] |
Salciccia S, Del Giudice F, Maggi M, Eisenberg ML, Chung BI, Conti SL, et al. Safety and feasibility of outpatient surgery in benign prostatic hyperplasia: a systematic review and metaanalysis. J Endourol 2021; 35:395-408.
doi: 10.1089/end.2020.0538
pmid: 33081521
|
| [23] |
Rosenhammer B, Lausenmeyer EM, Mayr R, Burger M, Eichelberg C. HoLEP provides a higher prostate cancer detection rate compared to bipolar TURP: a matched-pair analysis. World J Urol 2018; 36:2035-41.
doi: 10.1007/s00345-018-2353-0
pmid: 29858700
|
| [24] |
Gong YG, Liu RM, Gao R. Photoselective vaporesection of the prostate with a front-firing lithium triborate laser: surgical technique and experience after 215 procedures. Eur Urol 2015; 67:1152-9.
doi: 10.1016/j.eururo.2014.12.021
|
| [25] |
Cindolo L, Marchioni M, Emiliani E, Francesco PDE, Primiceri G, Castellan P, et al. Bladder neck contracture after surgery for benign prostatic obstruction. Minerva Urol Nefrol 2017; 69:133-43.
doi: 10.23736/S0393-2249.16.02777-6
pmid: 27905698
|
| [1] |
Jonathan Noël, Daniel Stirt, Marcio Covas Moschovas, Sunil Reddy, Abdel Rahman Jaber, Marco Sandri, Seetharam Bhat, Travis Rogers, Subuhee Ahmed, Anya Mascarenhas, Ela Patel, Vipul Patel. Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy: A propensity score matched analysis[J]. Asian Journal of Urology, 2024, 11(1): 19-25. |
| [2] |
Awad Elsid Osman, Sahar Alharbi, Atif Ali Ahmed, Asim Ali Elbagir. Single nucleotide polymorphism within chromosome 8q24 is associated with prostate cancer development in Saudi Arabia[J]. Asian Journal of Urology, 2024, 11(1): 26-32. |
| [3] |
Anthony Franklin, Troy Gianduzzo, Boon Kua, David Wong, Louise McEwan, James Walters, Rachel Esler, Matthew J. Roberts, Geoff Coughlin, John W. Yaxley. The risk of prostate cancer on incidental finding of an avid prostate uptake on 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography for non-prostate cancer-related pathology: A single centre retrospective study[J]. Asian Journal of Urology, 2024, 11(1): 33-41. |
| [4] |
Randi M. Pose, Sophie Knipper, Jonas Ekrutt, Mara Kölker, Pierre Tennstedt, Hans Heinzer, Derya Tilki, Florian Langer, Markus Graefen. Prevention of thromboembolic events after radical prostatectomy in patients with hereditary thrombophilia due to a factor V Leiden mutation by multidisciplinary coagulation management[J]. Asian Journal of Urology, 2024, 11(1): 42-47. |
| [5] |
Enrico Checcucci, Alberto Piana, Gabriele Volpi, Pietro Piazzolla, Daniele Amparore, Sabrina De Cillis, Federico Piramide, Cecilia Gatti, Ilaria Stura, Enrico Bollito, Federica Massa, Michele Di Dio, Cristian Fiori, Francesco Porpiglia. Three-dimensional automatic artificial intelligence driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy: A feasibility and accuracy study[J]. Asian Journal of Urology, 2023, 10(4): 407-415. |
| [6] |
Roxana Ramos-Carpinteyro, Ethan L. Ferguson, Jaya S. Chavali, Albert Geskin, Jihad Kaouk. First 100 cases of transvesical single-port robotic radical prostatectomy[J]. Asian Journal of Urology, 2023, 10(4): 416-422. |
| [7] |
Umberto Carbonara, Giuseppe Lippolis, Luciano Rella, Paolo Minafra, Giuseppe Guglielmi, Antonio Vitarelli, Giuseppe Lucarelli, Pasquale Ditonno. Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy: A single center analysis[J]. Asian Journal of Urology, 2023, 10(4): 423-430. |
| [8] |
Angelo Territo, Alessandro Uleri, Andrea Gallioli, Josep Maria Gaya, Paolo Verri, Giuseppe Basile, Alba Farré, Alejandra Bravo, Alessandro Tedde, Óscar Rodríguez Faba, Joan Palou, Alberto Breda. Robot-assisted oncologic pelvic surgery with Hugo™ robot-assisted surgery system: A single-center experience[J]. Asian Journal of Urology, 2023, 10(4): 461-466. |
| [9] |
Thomas Whish-Wilson, Jo-Lynn Tan, William Cross, Lih-Ming Wong, Tom Sutherland. Prostate magnetic resonance imaging and the value of experience: An intrareader variability study[J]. Asian Journal of Urology, 2023, 10(4): 488-493. |
| [10] |
Thitipat Hansomwong, Pat Saksirisampant, Sudhir Isharwal, Pubordee Aussavavirojekul, Varat Woranisarakul, Siros Jitpraphai, Sunai Leewansangtong, Tawatchai Taweemonkongsap, Sittiporn Srinualnad. Role of preoperative magnetic resonance imaging on the surgical outcomes of radical prostatectomy: Does preoperative tumor recognition reduce the positive surgical margin in a specific location? Experience from a Thailand prostate cancer specialized center[J]. Asian Journal of Urology, 2023, 10(4): 494-501. |
| [11] |
Kerri R. Beckmann, Michael E. O'Callaghan, Andrew D. Vincent, Kim L. Moretti, Nicholas R. Brook. Clinical outcomes for men with positive surgical margins after radical prostatectomy—results from the South Australian Prostate Cancer Clinical Outcomes Collaborative community-based registry[J]. Asian Journal of Urology, 2023, 10(4): 502-511. |
| [12] |
Wei He,Yutian Xiao,Shi Yan,Yasheng Zhu,Shancheng Ren. Cell-free DNA in the management of prostate cancer: Current status and future prospective[J]. Asian Journal of Urology, 2023, 10(3): 298-316. |
| [13] |
Shulin Wu,Sharron X. Lin,Kristine M. Cornejo,Rory K. Crotty,Michael L. Blute,Douglas M. Dahl,Chin-Lee Wu. Clinicopathological and oncological significance of persistent prostate-specific antigen after radical prostatectomy: A systematic review and meta-analysis[J]. Asian Journal of Urology, 2023, 10(3): 317-328. |
| [14] |
Stefano Alba,Deborah Fimognari,Fabio Crocerossa,Luigi Ascalone,Carmine Pullano,Fernando Chiaravalloti,Francesco Chiaradia,Umberto Carbonara,Matteo Ferro,Ottavio de Cobelli,Vincenzo Pagliarulo,Giuseppe Lucarelli,Michele Battaglia,Rocco Damiano,Francesco Cantiello. Neuraxial anesthesia versus general anesthesia in patients undergoing three-dimensional laparoscopic radical prostatectomy: Preliminary results of a prospective comparative study[J]. Asian Journal of Urology, 2023, 10(3): 329-336. |
| [15] |
Rajiv N. Kore. Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience[J]. Asian Journal of Urology, 2023, 10(2): 137-143. |
|
|
|
|
