Thromboembolic Events Following Surgery for Prostate Cancer

• Published in: European urology 2013-02, Vol.63 (2), p.354-363
• Main Authors: Van Hemelrijck, Mieke, Garmo, Hans, Holmberg, Lars, Bill-Axelson, Anna, Carlsson, Stefan, Akre, Olof, Stattin, Pär, Adolfsson, Jan
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Curative treatment; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Humans; Incidence; Lymph Node Excision - adverse effects; Lymph Node Excision - statistics & numerical data; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Nephrology. Urinary tract diseases; Orchiectomy - adverse effects; Orchiectomy - statistics & numerical data; Pelvis; Proportional Hazards Models; Prostate cancer; Prostatectomy - adverse effects; Prostatectomy - statistics & numerical data; Prostatic Neoplasms - surgery; Pulmonary Embolism - epidemiology; Pulmonary Embolism - etiology; Radical prostatectomy; Registries; Risk Factors; Sweden - epidemiology; Thromboembolism; Transurethral Resection of Prostate - adverse effects; Transurethral Resection of Prostate - statistics & numerical data; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; Venous Thrombosis - epidemiology; Venous Thrombosis - etiology
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2012.09.041

Abstract Background Prostate cancer (PCa) and surgery are both associated with increased risk of thromboembolic diseases (TED). Objective We assessed risk of TED among men undergoing different types of urologic surgery. Design, setting, and participants Using the Prostate Cancer Database Sweden (PCBaSe) Sweden, we identified all men ( n = 45 065) undergoing pelvic lymph node dissection (PLND), radical prostatectomy (RP) with or without PLND, orchiectomy due to PCa, or a transurethral resection of the prostate (TURP). We identified a comparison cohort from the population. Outcome measurements and statistical analysis Main outcomes were deep venous thrombosis (DVT) and pulmonary embolism (PE) as primary diagnoses in the National Patient Register or Cause of Death Register (2002–2010). We calculated hazard ratios (HR) and 95% confidence intervals (CI) using multivariable Cox proportional hazards models. Results and limitations All surgical procedures were associated with increased risk of TED; laparoscopic and open RP with a PLND were the most strongly associated with TED (HR for PE: 8.1 [95% CI, 2.9–23.0] and 7.8 [95% CI, 4.9–13], respectively). For surgery including a PLND, the risk increased during the second half of the first postoperative month. The HR for PE after TURP in men with PCa was 3.0 (95% CI, 1.8–5.1). Patients with a history of TED had a strongly increased risk of TED (HR for DVT: 4.5; 95% CI, 2.6–8.0). A limitation is lack of information on TED prophylaxis, but its use was standardized during the study period for RP and PLND. Other limitations are lack of information on extent of PLND and lifestyle factors. Conclusions Surgeries for PCa, including TURP, are associated with hospitalization for TED. Patients with a history of TED and patients undergoing a PLND were at highest risk. The largest risk was observed from days 14 to 28 postoperatively. Thus, our results suggest that prophylactic measures may be beneficial during the first 4 wk in these patients.