Impact of prior prostate radiation on complications after radical prostatectomy Journal Article
| Authors: | Gotto, G. T.; Yunis, L. H.; Vora, K.; Eastham, J. A.; Scardino, P. T.; Rabbani, F. |
| Article Title: | Impact of prior prostate radiation on complications after radical prostatectomy |
| Abstract: | Purpose: Salvage radical prostatectomy is associated with a higher complication rate than radical prostatectomy without prior radiotherapy but the magnitude of the increase is not well delineated. Materials and Methods: A total of 3,458 consecutive patients underwent open radical prostatectomy and 98 underwent open salvage radical prostatectomy from January 1999 to June 2007. Data were collected from prospective surgical and institutional morbidity databases, and retrospectively from billing records and medical records. Medical and surgical complications were captured, graded by the modified Clavien classification and classified by time of onset. Results: Median followup after salvage radical prostatectomy and radical prostatectomy was 34.5 and 45.5 months, respectively. Patients with salvage had significantly higher median age, modified Charlson comorbidity score, clinical and pathological stage, and Gleason score. They were less likely to have organ confined disease and more likely to have seminal vesicle invasion and nodal metastasis. There was no significant difference in median operative time, blood loss or transfusion rate. The salvage group had a higher adjusted probability of medical and surgical complications, including urinary tract infection, bladder neck contracture, urinary retention, urinary fistula, abscess and rectal injury. Only 1 of 4 potent patients with salvage prostatectomy who underwent bilateral nerve sparing recovered erection adequate for intercourse. The 3-year actuarial recovery of continence was 30% (95% CI 19-41). Conclusions: Medical and surgical complications of prostatectomy are significantly increased in the setting of prior radiotherapy. Understanding the magnitude of this increased risk is important for patient counseling. © 2010 American Urological Association Education and Research, Inc. |
| Keywords: | controlled study; treatment outcome; survival rate; retrospective studies; major clinical study; postoperative period; salvage therapy; disease classification; cancer radiotherapy; cancer staging; follow up; follow-up studies; lymph node metastasis; lymphatic metastasis; neoplasm staging; bleeding; lung disease; incidence; morbidity; risk factors; medical record review; retrospective study; prostate cancer; postoperative complication; postoperative complications; cancer invasion; gleason score; prostatic neoplasms; prostate; prostatectomy; cardiovascular disease; operation duration; urinary tract infection; comorbidity; scoring system; blood transfusion; postoperative infection; complications; chi-square distribution; neoplasm invasiveness; seminal vesicle; convalescence; neurologic disease; urine retention; gastrointestinal disease; statistics, nonparametric; patient counseling; sexual intercourse; bladder disease; penis erection; venous thromboembolism; seminal vesicles; urinary tract fistula; abscess; bladder neck contracture; partial body radiation; rectum injury |
| Journal Title: | Journal of Urology |
| Volume: | 184 |
| Issue: | 1 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2010-07-01 |
| Start Page: | 136 |
| End Page: | 142 |
| Language: | English |
| DOI: | 10.1016/j.juro.2010.03.031 |
| PUBMED: | 20478594 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: JOURA" - "Source: Scopus" |
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