Cytoreductive Surgery for Metastatic PCa Linked to More Complications

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Cytoreductive radical prostatectomy (RP) for metastatic prostate cancer (PCa) is associated with higher complication rates and longer hospital stays than RP for non-metastatic PCa.
Cytoreductive radical prostatectomy (RP) for metastatic prostate cancer (PCa) is associated with higher complication rates and longer hospital stays than RP for non-metastatic PCa.

Cytoreductive radical prostatectomy (RP) for patients with metastatic prostate cancer (PCa) is associated with higher complication rates than RP for non-metastatic PCa, new study findings suggest.

Using the National Inpatient Sample database (2008 – 2013), Felix Preisser, MD, of the University of Montreal Health Center in Canada, and colleagues identified 76,378 patients who underwent RP for PCa. Of these, 953 (1.2%) underwent cytoreductive RP and 75,425 (98.8%) had RP for non-metastatic PCa (nmRP). The overall complication rate was 14.9% in the cytoreductive group compared with 12.3% for the nmRP group, a significant difference between the treatment arms, the investigators reported online ahead of print in European Urology.

After propensity score matching, cytoreductive RP was associated with significant 34% increased odds of complications overall, 2.6-fold increased odds of intraoperative complications, and 1.7-fold increased odds of miscellaneous surgical complication compared with nmRP.

In addition, cytoreductive RP was associated with a significantly long hospital stay and higher total hospital charges.

The authors concluded that intra- and postoperative complications associated with cytoreductive RP are higher than those of nmRP. Cytoreductive RP complication rates “appear manageable but require explicit discussion at counseling.”

The study's retrospective design and lack of information about tumor characteristics were among its limitations, Dr Preisser and his colleagues noted. In addition, propensity score matching and multivariable adjustments were unable to account for potential differences in tumor characteristics between cytoreductive RP and nmRP patients.

Reference

Preisser F, Mazzone E, Nazzani S, et al. Comparison of perioperative outcomes between cytoreductive radical prostatectomy and radical prostatectomy for nonmetastatic prostate cancer. Eur Urol. 2018; published online ahead of print.

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