Peri-operative outcomes following radical prostatectomy in the setting of advanced prostate cancer

Rishabh K Simhal; Kerith R Wang; Yash B Shah; Costas D Lallas; Mihir S Shah; Thenappan Chandrasekar

doi:10.1111/bju.16370

Peri-operative outcomes following radical prostatectomy in the setting of advanced prostate cancer

BJU Int. 2024 Apr 23. doi: 10.1111/bju.16370. Online ahead of print.

Authors

Rishabh K Simhal¹, Kerith R Wang², Yash B Shah², Costas D Lallas², Mihir S Shah², Thenappan Chandrasekar³

Affiliations

¹ Department of Urology, Ochsner Medical Center, New Orleans, Louisiana, USA.
² Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
³ Department of Urology, University of California, Davis, Sacramento, California, USA.

PMID: 38653516
DOI: 10.1111/bju.16370

Abstract

Objective: To compare the peri-operative outcomes of radical prostatectomy (RP) for locally advanced, node-positive, and metastatic prostate cancer (PCa), as determined through pathological staging, using the American College of Surgeons National Surgical Quality Improvement Project.

Methods: We identified RP procedures performed between 2019 and 2021. Patients were stratified by pathological staging to compare the effect of locally advanced disease (T3-4), node positivity (N+) and metastasis (M+) vs localised PCa (T1-2 N0 M0). Baseline demographics and 30-day outcomes, including operating time, length of hospital stay (LOS), 30-day mortality, readmissions, reoperations, major complications, minor complications and surgery-specific complications, were compared between groups.

Results: Pathological staging data were available for 9276 RPs. Baseline demographics were comparable. There was a slightly higher rate of minor complications in the locally advanced cohort, but no significant difference in major complications, 30-day mortality, readmissions, or rectal injuries. Node positivity was associated with longer operating time, LOS, and some slightly increased rates of 30-day complications. RP in patients with metastatic disease appeared to be similarly safe to RP in patients with M0 disease, although it was associated with a longer LOS and slightly increased rates of certain complications.

Conclusions: For patients with pathologically determined locally advanced, node-positive, and metastatic PCa, RP appears to be safe, and is not associated with significantly higher rates of 30-day mortality or major complications compared to RP for localised PCa. This study adds to the growing body of literature investigating the role of RP for advanced PCa; further studies are needed to better characterise the risks and benefits of surgery in such patients.

Keywords: NSQIP; metastatic; peri‐operative outcomes; prostate cancer; radical prostatectomy.