1753 COMPARATIVE EFFECTIVENESS OF SURGICAL TREATMENTS FOR PROSTATE CANCER: A POPULATION-BASED ANALYSIS OF POSTOPERATIVE OUTCOMES

Vol. 183, No. 4, Supplement, Tuesday, June 1, 2010

1751 12-MONTH URINARY CONTINENCE FOLLOWING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Giacomo Novara*, Carolina D’Elia, Silvia Secco, Antonio Cioffi, Massimo Iafrate, Vincenzo Ficarra, Walter Artibani, Padua, Italy INTRODUCTION AND OBJECTIVES: To evaluate the rate return to continence following robot-assisted laparoscopic radical prostatectomy (RALP) and the independent predictors at a minimum 12 month follow-up. METHODS: We collected prospectively the data of 304 consecutive patients who received RALP for clinically localized prostate cancer from April 2005 to June 2008. Two surgeons performer all the procedures with the same technique. All the patients who reported no urinary leakage or less than a single episode per week of leakage at ICI-q questionnaire were considered continent. Pearson’s chi square, Mann-Whitney U test, and logistic regression were used for univariable and multivariable analyses, as appropriate. A 2-sided p ⬍ 0.05 was considered statistically significant. R-square was used to evaluate the strength of the correlation between surgical times and learning curve. All statistical tests were performed with SPSS version 16.0 (SPSS Inc, Chicago, IL, USA). RESULTS: Mean patients’ age at surgery was di 61.6⫹/-6 years. Mean age-adjusted Charlson comorbidity index was 3.8⫹/-1. Median PSA at diagnosis was 6.3 ng/ml (interquartile range [IQR] 4.6-8.4). According to the D’amico risk group, low, intermediate, and high risk cancer was present in 70%, 23%, and 7% of the patients, respectively. The median follow-up was 14 months (IQR 12-15). Al follow-up, 286 patients (94%) were continent. Mean time to return to continence was 53⫹/-82 days. The incontinent patients used a median number of 1 pad (IQR 1-2) during the day. In univariable analysis, age-adjusted Charlson comorbidity index score (3.7⫹/-1 in the continent patients vs 4.4⫹/-1.1 in the incontinent one; p⫽0.003), and ECOG performance status ( 0 in 88% of the continent patients vs 78% of the incontinent ones; p⫽0.022) were significantly associated with return to continence. None of the variables regarding prostate cancer and the surgical procedure resulted in being statistically significant. In multivariable analyses, age-adjusted Charlson comorbidity index (continuous variable: H.R. 1.6; p⫽ 0.002; ⬍/⫽ vs ⬎4: H.R. 2.4; p⫽0.02) was the only independent predictor of return to continence. CONCLUSIONS: Using a validated tool such as ICIq to report urinary continence following RALP, we reported excellent continence rate at 14-mo follow-up. Age-adjusted Charlson comorbidity index was the only independent predictor of return to continence, while none of the variables regarding prostate cancer or the surgical procedures were significant even in univariable analysis. Source of Funding: None

1752 PREVENTING THROMBOEMBOLIC COMPLICATIONS AFTER RADICAL RETROPUBIC PROSTATECTOMY WITH COMPRESSION STOCKINGS AND AMBULATION ONLY Jessica T. Casey*, Ronald J. Kim, Matthias D. Hofer, Brian T. Helfand, Stacy Loeb, Norm D. Smith, William J. Catalona, Chicago, IL INTRODUCTION AND OBJECTIVES: Despite the American College of Chest Physicians’ recommendation of routine thromboembolic prophylaxis with low-dose unfractionated heparin during open urologic surgery, there is no consensus on its use for open radical retropubic prostatectomy (RRP). Prior studies have suggested that venous thromboembolism (VTE) occurs in 0.2% to 3.6% of patients undergoing RRP. In the absence of a randomized trial or cohort study, we retrospectively reviewed the incidence of clinically evident VTE in a contemporary RRP series. METHODS: From 2003-2009, 1471 men underwent RRP by a single surgeon. Clinical characteristics and outcomes were recorded in

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a prospective database. Our primary endpoint was clinical VTE, such as deep vein thrombosis (DVT) or pulmonary embolus (PE). Our method of prophylaxis consisted of thromboembolic deterrent stockings (TEDs) with early and frequent ambulation for the majority of patients. Patients who were considered “high-risk” by virtue of a prior history of DVT or PE were additionally treated with sequential compression devices (SCDs), as well as intraoperative and postoperative low-dose heparin. RESULTS: 99% of procedures required minimal prophylaxis with TEDs and early ambulation, while 1% were considered high-risk and required SCDs and low-dose heparin. All VTE occurred in low-risk patients. 8 (0.5%) patients had a clinically evident DVT, and 3 (0.2%) had a PE, yielding an overall frequency of 0.7%. There was no association between VTE and patient demographics. No patient who received heparin had clinical evidence of lymphocele formation. There were also no fatal thromboembolic complications in this series. CONCLUSIONS: In our series, a prophylactic strategy involving TEDs and early ambulation was successful for the prevention of VTE in the great majority of patients undergoing RRP. In patients with a history of VTE, no clinically evident thromboembolic events occurred with the addition of SCDs and mini-dose heparin. Unlike other major surgical procedures for the treatment of malignancy, the rate of VTE following RRP is exceedingly low, suggesting that a less aggressive prophylactic strategy yields acceptable outcomes. Source of Funding: Supported in part by the Urological Research Foundation, Prostate SPORE grant (P50 CA9038605S2) and the Robert H. Lurie Comprehensive Cancer Center grant (P30 CA60553)

1753 COMPARATIVE EFFECTIVENESS OF SURGICAL TREATMENTS FOR PROSTATE CANCER: A POPULATION-BASED ANALYSIS OF POSTOPERATIVE OUTCOMES William Lowrance*, James Eastham, Lindsay Jacks, David Yee, Thomas Jang, Vincent Laudone, Bertrand Guillonneau, Peter Scardino, Elena Elkin, New York, NY INTRODUCTION AND OBJECTIVES: Enthusiasm for laparoscopic surgical approaches to prostate cancer treatment has grown, despite limited evidence of improved outcomes compared with open radical prostatectomy. We compared laparoscopic (with or without robotic assistance) versus open radical prostatectomy in terms of postoperative outcomes and subsequent cancer-directed therapy. METHODS: Using a population-based cancer registry linked with Medicare claims, we identified men age 66 or older with localized prostate cancer who received a radical prostatectomy from 2003-2005. Outcome measures were general medical/surgical complications and mortality within 90 days following surgery; genitourinary/bowel complications within 365 days; receipt of radiation therapy, androgen deprivation therapy or both within 365 days; length of hospital stay. RESULTS: Of the 5,923 men,18% received a laparoscopic radical prostatectomy. Adjusting for patient and tumor characteristics, there were no differences in rates of general medical/surgical complications (OR 0.93; 95% CI: 0.77-1.14) or genitourinary/bowel complications (OR 0.96; 95% CI: 0.76-1.22) or in the use of postoperative radiation, androgen deprivation or both (OR 0.80; 95% CI: 0.60-1.08). Laparoscopic prostatectomy was associated with a 35% shorter hospital stay (p⬍0.0001) and a lower rate of bladder neck/urethral obstruction (OR 0.74; 95% CI 0.58-0.94). In laparoscopic patients, surgeon volume was inversely associated with length of hospital stay and the odds of any genitourinary/bowel complication. CONCLUSIONS: Laparoscopic and open radical prostatectomy have similar rates of postoperative morbidity and use of additional treatment. Men considering prostate cancer surgery should understand the expected benefits and risks of each technique to facilitate decisionmaking and to set realistic expectations. Source of Funding: NIH T32-CA82088 to P.S. and W.L.; NCI P50-CA92629 SPORE to P.S., CA118189-01A2 to E.E