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1083 PATHOLOGICAL OUTCOMES IN PATIENTS WITH CLINICALLY LOW-RISK PROSTATE CANCER DEEMED ELIGIBLE FOR ACTIVE SURVEILLANCE
13.4 vs. 6.3%, respectively (P=0.02). The rates of PL in patients receiving highdose LWMH vs. those receiving regular dosage were 5.4 and 8.6%, respectively (P=0.3). In patients undergoing LND vs. those LND was omitted, PL occurred in 13.0 and 1.5%, respectively (P<0.001). After adjusting for all covariates, patients receiving high-dose LMWH were 2.3-fold more likely to be transfused than patients with regular LMWH regimen (P=0.02). In multivariable analysis for prediction of PL, only LND achieved independent predictor status (odds ratio [OR]: 8.1, P=0.001). High-dose LMWH and all other covariates were unrelated to PL formation. Conclusions: Patients with perioperative need for high-dose LMWH in ORP are more likely to receive a blood transfusion, whereas PL formation seems to be unaffected. This finding has important implications for informed consent.
1081
Open radical prostatectomy (ORP) performed by low volume surgeons predisposes to higher rates of venous thrombosis (VT) and pulmonary embolism (PE)
Schmitges J.H.M.1, Budäus L.2, Jeldres C.3, Djahangirian O.3, Ismail S.3, Hansen J.1, Chun F.K.2, Karakiewicz P.I.4 1 Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany, 2 University Hospital Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany, 3 University of Montreal Health Center, Dept. of Urology, Montreal, Canada, 4 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada Introduction & Objectives: VT and PE are highly unfavourable outcomes after ORP and may lead to higher mortality. The latest and most contemporary report (n=4592) reported that the rate of VT and PE are 1.4 and 0.9%, respectively. The reported rates originate from a single center of excellence and may not be representative. We examined the most contemporary VT and PE rates and temporal trends in a large population-based cohort. Materials & Methods: Between 1999 and 2008, 34653 ORPs were performed in the state of Florida. Rates and trends of VT and PE were assessed. Univariable and multivariable logistic regression analyses focused on prediction of VT and PE. Predictors included age, race, surgical volume tertiles (SV), and baseline Charlson Comorbidity Index (CCI). Results: The overall VT and PE rate was 0.2% respectively. The rate of VT (0.30.2%, P=0.3) and PE (0.1-0.1%, P=0.5) remained stable over the study period. VT was indirectly related to SV: VT rate was 0.3% at ORP performed within the low SV tertile vs. 0.1% in respectively the intermediate and high SV tertile (P<0.001). In 21.3% of patients suffering from VT, a PE also occurred (P<0.001). PE was significantly higher in patients operated within the low and intermediate SV tertile vs. those operated in the high SV tertile (0.2 vs. 0.2 vs. 0.1%, P=0.02). In-hospital mortality rate was 0.07% in patients not suffering from PE and 11.3% in patients with PE (P<0.001). After adjusting for all covariates, patients operated by low SV surgeons were 3.7 times more likely to have VT than patients operated by high SV surgeons (P=0.001). In multivariable analysis for prediction of PE, patients operated within the low SV tertile were 2.6-fold more likely to suffer from PE vs. those operated in the intermediate and high SV tertile (P=0.02). Surprisingly, age and CCI failed to reach statistical significance in univariable and multivariable analyses for both end points. Conclusions: VT and PE represent an important detrimental outcome after ORP. PE increases the risk of in-hospital mortality substantially. Patients operated by low SV surgeons are at higher risk of VT and PE than these of high SV surgeons. These data have important practice implications.
1082
The effects of previous preperitoneal inguinal hernia repair on operative and functional outcomes of open, retropubic radical prostatectomy: A case-matched analysis
Peeters E.1, Joniau S.2, Miserez M.1 1 University Hospitals Leuven, Dept. of Abdominal Surgery, Leuven, Belgium, 2 University Hospitals Leuven, Dept. of Urology, Leuven, Belgium Introduction & Objectives: The effects of the presence of a mesh in the preperitoneal space, after hernia repair, on future pelvic surgery are still subject of debate. This retrospective study aimed to investigate the impact of previous preperitoneal tension-free inguinal hernia repair on the operative and short- and long-term functional outcomes of open, retropubic radical prostatectomy. Materials & Methods: Sixty patients undergoing open, retropubic radical prostatectomy for prostate cancer, with a history of laparoscopic or open, preperitoneal inguinal hernia repair were identified. Case-controls (n = 60) were matched for age, BMI and oncologic status (preoperative PSA value, clinical T status and pathological Gleason score). Perioperative data (operative time, amount of blood loss, degree of nerve sparing, ability to perform lymphadenectomy and surgeon’s assessment of technical difficulty), pathological aspects (number of lymph nodes removed and presence of positive surgical margins) and shortterm (hospitalisation and urinary catheterisation time) and long-term (recurrence rate, sexual potency and urinary continence status) outcome parameters were analysed.
Results: In patients with previous preperitoneal inguinal hernia repair, operative time was significantly longer (100 versus 90 min; p < 0.001), lymphadenectomy was significantly less frequent (35 versus 57 patients; p < 0.001) and the operation was assessed significantly more difficult by the surgeon (grade 3 versus 2; p = 0.022). Intra-operative blood loss and degree of nerve sparing were, however, comparable. Significantly less lymph nodes were present in resected lymph node specimens in study patients (2.5 versus 8; p < 0.001), but the number of patients with positive surgical margins was not significantly different. A significantly longer median hospital stay (7 versus 6 days; p = 0.012) and urinary catheterization (13 versus 11 days; p = 0.006) was also noted for study patients. Finally, both groups were comparable regarding recurrence rate and patients’ urinary continence and sexual potency status at long-term (2.5 years) follow-up. Conclusions: Our data demonstrate that open, retropubic radical prostatectomy is feasible in patients with a history of preperitoneal inguinal hernia repair, but is associated with a more complex operative procedure, prolonged hospital course and less adequate lymphadenectomy, while long-term functional and oncologic parameters are not affected.
1083
Pathological outcomes in patients with clinically low-risk prostate cancer deemed eligible for active surveillance
Srivastava A., Grover S., Sooriakumaran P., Leung R., Tewari A. Weill Cornell Medical College, Dept. of Urology, New York, United States of America Introduction & Objectives: Active surveillance (AS) is becoming increasingly popular as a treatment option for men with clinically localized low-risk prostate cancer. Gleason score ≤6 and clinical stage ≤T2a are selection criterion for AS. However, Gleason upgrading or upstaging from diagnostic biopsy to surgical specimen is not uncommon. We thus sought to identify risk factors that could more accurately predict either Gleason upgrading and/or upstaging in AS-eligible men. Materials & Methods: 786 patients from our prospective database of 2412 men who underwent robotic-assisted radical prostatectomy by a single surgeon from January 2005 to August 2010 would have fulfilled standard AS criteria (Gleason sum ≤ 6, clinical stage ≤T2a disease, PSA <10ng/ml, <3 positive cores and ≤50% cancer present in a single core). This formed the basis of our study cohort. Clinicopathologic parameters, including number of cores at initial biopsy, biopsy cancer volume, preoperative PSA, number of cancer-positive cores, body mass index, and prostate volume were recorded prospectively. Data were evaluated using chi-square and multivariate logistic regression analyses. Receiver operator characteristic curves (ROC) were constructed to determine the optimal cut-off values.
Results: 320 of 786 AS-eligible patients (40.7%) had Gleason upgrading at final pathology following radical prostatectomy. Upstaging was present in 591 patients (75.1%). There were a total of 626 patients (79.6%) who had Gleason upgrading and/or upstaging. On univariate analysis, BMI, PSA density, preoperative PSA, lower prostate volume and maximum percentage of cancer in biopsy cores were predictors in patients with either Gleason upgrading and/or upstaging. On multivariate analysis, all variables, except for BMI and PSA density, lost statistical significance. PSA density > 0.1ng/ml/cm3 and BMI >29kg/m2 are the optimal cut-off values based on ROC analysis. Conclusions: PSA density and BMI are significant predictors of Gleason upgrading and/or upstaging, and should be incorporated into contemporary selection criteria for AS protocols.
1084
The effect of pelvic dimensions on clinical and pathological outcome after radical retropubic prostatectomy
Karadeniz T., Oezkaptan O., Guzelburc V., Yilmaz K., Yilanoglu R.O. Okmeydanı Training and Research Hospital, Dept. of 2. Urology, Istanbul, Turkey Introduction & Objectives: To determine the effect of pelvic dimensions and prostate volume, measured by preoperative pelvic magnetic resonance imaging(MRI) , on margin status, preoperative and postoperative estimated blood loss and transfusion rate at radical retropubic prostatectomy. Materials & Methods: The data of 73 patients with adequate preoperative prostate magnetic resonance imaging were analyzed retrospectively. Bony and soft –tissue pelvic dimensions , including interspinous distance (ISD), bony (BFW) and soft tissue (SW) pelvic width, apical prostate depth, upper conjugate (UC), lower conjugate (LC), pelvic depth and symphysis pubis angle (SPA), were measured
Eur Urol Suppl 2011;10(2):333
1081
Open radical prostatectomy (ORP) performed by low volume surgeons predisposes to higher rates of venous thrombosis (VT) and pulmonary embolism (PE)
Schmitges J.H.M.1, Budäus L.2, Jeldres C.3, Djahangirian O.3, Ismail S.3, Hansen J.1, Chun F.K.2, Karakiewicz P.I.4 1 Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany, 2 University Hospital Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany, 3 University of Montreal Health Center, Dept. of Urology, Montreal, Canada, 4 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada Introduction & Objectives: VT and PE are highly unfavourable outcomes after ORP and may lead to higher mortality. The latest and most contemporary report (n=4592) reported that the rate of VT and PE are 1.4 and 0.9%, respectively. The reported rates originate from a single center of excellence and may not be representative. We examined the most contemporary VT and PE rates and temporal trends in a large population-based cohort. Materials & Methods: Between 1999 and 2008, 34653 ORPs were performed in the state of Florida. Rates and trends of VT and PE were assessed. Univariable and multivariable logistic regression analyses focused on prediction of VT and PE. Predictors included age, race, surgical volume tertiles (SV), and baseline Charlson Comorbidity Index (CCI). Results: The overall VT and PE rate was 0.2% respectively. The rate of VT (0.30.2%, P=0.3) and PE (0.1-0.1%, P=0.5) remained stable over the study period. VT was indirectly related to SV: VT rate was 0.3% at ORP performed within the low SV tertile vs. 0.1% in respectively the intermediate and high SV tertile (P<0.001). In 21.3% of patients suffering from VT, a PE also occurred (P<0.001). PE was significantly higher in patients operated within the low and intermediate SV tertile vs. those operated in the high SV tertile (0.2 vs. 0.2 vs. 0.1%, P=0.02). In-hospital mortality rate was 0.07% in patients not suffering from PE and 11.3% in patients with PE (P<0.001). After adjusting for all covariates, patients operated by low SV surgeons were 3.7 times more likely to have VT than patients operated by high SV surgeons (P=0.001). In multivariable analysis for prediction of PE, patients operated within the low SV tertile were 2.6-fold more likely to suffer from PE vs. those operated in the intermediate and high SV tertile (P=0.02). Surprisingly, age and CCI failed to reach statistical significance in univariable and multivariable analyses for both end points. Conclusions: VT and PE represent an important detrimental outcome after ORP. PE increases the risk of in-hospital mortality substantially. Patients operated by low SV surgeons are at higher risk of VT and PE than these of high SV surgeons. These data have important practice implications.
1082
The effects of previous preperitoneal inguinal hernia repair on operative and functional outcomes of open, retropubic radical prostatectomy: A case-matched analysis
Peeters E.1, Joniau S.2, Miserez M.1 1 University Hospitals Leuven, Dept. of Abdominal Surgery, Leuven, Belgium, 2 University Hospitals Leuven, Dept. of Urology, Leuven, Belgium Introduction & Objectives: The effects of the presence of a mesh in the preperitoneal space, after hernia repair, on future pelvic surgery are still subject of debate. This retrospective study aimed to investigate the impact of previous preperitoneal tension-free inguinal hernia repair on the operative and short- and long-term functional outcomes of open, retropubic radical prostatectomy. Materials & Methods: Sixty patients undergoing open, retropubic radical prostatectomy for prostate cancer, with a history of laparoscopic or open, preperitoneal inguinal hernia repair were identified. Case-controls (n = 60) were matched for age, BMI and oncologic status (preoperative PSA value, clinical T status and pathological Gleason score). Perioperative data (operative time, amount of blood loss, degree of nerve sparing, ability to perform lymphadenectomy and surgeon’s assessment of technical difficulty), pathological aspects (number of lymph nodes removed and presence of positive surgical margins) and shortterm (hospitalisation and urinary catheterisation time) and long-term (recurrence rate, sexual potency and urinary continence status) outcome parameters were analysed.
Results: In patients with previous preperitoneal inguinal hernia repair, operative time was significantly longer (100 versus 90 min; p < 0.001), lymphadenectomy was significantly less frequent (35 versus 57 patients; p < 0.001) and the operation was assessed significantly more difficult by the surgeon (grade 3 versus 2; p = 0.022). Intra-operative blood loss and degree of nerve sparing were, however, comparable. Significantly less lymph nodes were present in resected lymph node specimens in study patients (2.5 versus 8; p < 0.001), but the number of patients with positive surgical margins was not significantly different. A significantly longer median hospital stay (7 versus 6 days; p = 0.012) and urinary catheterization (13 versus 11 days; p = 0.006) was also noted for study patients. Finally, both groups were comparable regarding recurrence rate and patients’ urinary continence and sexual potency status at long-term (2.5 years) follow-up. Conclusions: Our data demonstrate that open, retropubic radical prostatectomy is feasible in patients with a history of preperitoneal inguinal hernia repair, but is associated with a more complex operative procedure, prolonged hospital course and less adequate lymphadenectomy, while long-term functional and oncologic parameters are not affected.
1083
Pathological outcomes in patients with clinically low-risk prostate cancer deemed eligible for active surveillance
Srivastava A., Grover S., Sooriakumaran P., Leung R., Tewari A. Weill Cornell Medical College, Dept. of Urology, New York, United States of America Introduction & Objectives: Active surveillance (AS) is becoming increasingly popular as a treatment option for men with clinically localized low-risk prostate cancer. Gleason score ≤6 and clinical stage ≤T2a are selection criterion for AS. However, Gleason upgrading or upstaging from diagnostic biopsy to surgical specimen is not uncommon. We thus sought to identify risk factors that could more accurately predict either Gleason upgrading and/or upstaging in AS-eligible men. Materials & Methods: 786 patients from our prospective database of 2412 men who underwent robotic-assisted radical prostatectomy by a single surgeon from January 2005 to August 2010 would have fulfilled standard AS criteria (Gleason sum ≤ 6, clinical stage ≤T2a disease, PSA <10ng/ml, <3 positive cores and ≤50% cancer present in a single core). This formed the basis of our study cohort. Clinicopathologic parameters, including number of cores at initial biopsy, biopsy cancer volume, preoperative PSA, number of cancer-positive cores, body mass index, and prostate volume were recorded prospectively. Data were evaluated using chi-square and multivariate logistic regression analyses. Receiver operator characteristic curves (ROC) were constructed to determine the optimal cut-off values.
Results: 320 of 786 AS-eligible patients (40.7%) had Gleason upgrading at final pathology following radical prostatectomy. Upstaging was present in 591 patients (75.1%). There were a total of 626 patients (79.6%) who had Gleason upgrading and/or upstaging. On univariate analysis, BMI, PSA density, preoperative PSA, lower prostate volume and maximum percentage of cancer in biopsy cores were predictors in patients with either Gleason upgrading and/or upstaging. On multivariate analysis, all variables, except for BMI and PSA density, lost statistical significance. PSA density > 0.1ng/ml/cm3 and BMI >29kg/m2 are the optimal cut-off values based on ROC analysis. Conclusions: PSA density and BMI are significant predictors of Gleason upgrading and/or upstaging, and should be incorporated into contemporary selection criteria for AS protocols.
1084
The effect of pelvic dimensions on clinical and pathological outcome after radical retropubic prostatectomy
Karadeniz T., Oezkaptan O., Guzelburc V., Yilmaz K., Yilanoglu R.O. Okmeydanı Training and Research Hospital, Dept. of 2. Urology, Istanbul, Turkey Introduction & Objectives: To determine the effect of pelvic dimensions and prostate volume, measured by preoperative pelvic magnetic resonance imaging(MRI) , on margin status, preoperative and postoperative estimated blood loss and transfusion rate at radical retropubic prostatectomy. Materials & Methods: The data of 73 patients with adequate preoperative prostate magnetic resonance imaging were analyzed retrospectively. Bony and soft –tissue pelvic dimensions , including interspinous distance (ISD), bony (BFW) and soft tissue (SW) pelvic width, apical prostate depth, upper conjugate (UC), lower conjugate (LC), pelvic depth and symphysis pubis angle (SPA), were measured
Eur Urol Suppl 2011;10(2):333