2008 Annual Meeting Abstracts

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Perioperative Complications of Radical Prostatectomy
Wilmer B Roberts, Kenneth Tseng*, Christian Pavlovich, David Chan, Li-Ming Su, Patrick C Walsh, Misop Han
Johns Hopkins, Baltimore, MD

Introduction:
Since the development of anatomic radical retropubic prostatectomy (RRP), the morbidity and mortality associated with radical prostatectomy has drastically decreased. Minimally invasive approaches to radical prostatectomy, like laparoscopic radical prostatectomy (LRP), are becoming more popular with the hope of minimizing perioperative morbidity and facilitating faster recovery. We compared perioperative complications of contemporary RRP and LRP - with and without robotic assistance - performed by multiple surgeons in a high-volume tertiary care center.
Methods:
Departmental morbidity and mortality records between 1997 and 2007 were reviewed, and all complications of RRP and LRP in our institution were categorized. LRP was then stratified by year to account for progression in surgical skill along the learning curve.
Results:

	RRP 1997-2007	LRP 2001-2004	LRP 2005-2007
Total # cases	10183	416	863
Complication Type	%	%	%
Technical/Surgical Injury (eg: ureteral, obturator nerve, rectal)	0.40	1.68	0.70
Surgical-site Related (eg: wound infection, abscess)	0.45	1.44	0.46
Infection (eg: UTI, C.diff colitis)	0.07	-----	0.12
Bleeding Requiring hemodynamic monitoring+transfusions Requiring reexploration	0.34 0.19 0.16	0.72 0.48 0.24	0.23 ---- 0.23
Thromboembolic (DVT/PE)	0.55	0.72	0.58
Cardio-/Cerebrovascular	0.08	0.24	-----
Bowel related (eg: ileus, SBO)	0.66	1.20	0.81
Medical (eg: Pneumonia, ARF, AMS, immunologic)	0.57	0.24	0.81
Positional (eg: shoulder injury, compartment syndr)	0.05	-----	-----
Foley dislodgement	0.06	0.24	0.12
Aborted procedure open conversion	0.06	----- 1.44	0.12 -----
Reexploration (not due to bleeding)	0.16	0.96	0.23
Anesthesia-related	0.08	0.24	0.35
Misc	0.21	0.96	0.23
Total Morbidity	3.89%	10.32%	4.98%
Mortality	0.03%	-----	0.12%

With improvement in surgical skill and technique, the rate of complicated bleeding requiring hemodynamic monitoring and serial transfusion is lower in LRP (0.23%) than RRP (0.34%). However, there is a non-significant (all p-values derived between RRP (1997-2007) and LRP (2005-2007) > 0.1) increased risk of anesthetic, medical, and bowel-related complications in LRP than RRP.
Conclusions:
Perioperative complications of RRP and LRP are rare at a high-volume, tertiary referral center. Although the differences in most categories did not appear significant, complications were more common in the LRP group than the RRP group. The rate of technical complications of LRP, however, is rapidly approaching the RRP baseline, as is the overall morbidity.

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