Publication Abstract

Authors: Loeb S, Meyer C, Krasnova A, Curnyn C, Reznor G, Lepor H, Kibel AS, Trinh QD


Journal: J Endourol :-

Date: 2016 Sep 11

Abstract: BACKGROUND AND PURPOSE: Whereas open radical prostatectomy is performed extraperitoneally, minimally invasive radical prostatectomy is typically performed within the peritoneal cavity. To determine whether minimally invasive radical prostatectomy is associated with an increased risk of small bowel obstruction compared to open radical prostatectomy. PATIENTS AND METHODS: In the U.S. Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified 14,147men diagnosed with prostate cancer from 2000 to 2008 treated by open (n=10,954) or minimally invasive (n=3,193) radical prostatectomy. Multivariable Cox proportional hazards models were used to examine the impact of surgical approach on the diagnosis of small bowel obstruction, as well as the need for lysis of adhesions and exploratory laparotomy. RESULTS: During a median follow-up of 45 and 76 months, respectively, the cumulative incidence of small bowel obstruction was 3.7% for minimally invasive and 5.3% for open radical prostatectomy (p=0.0005). Lysis of adhesions occurred in 1.1% of minimally invasive and 2.0% of open prostatectomy patients (p=0.0003). On multivariable analysis, there was no significant difference between minimally invasive and open prostatectomy with respect to small bowel obstruction (HR 1.17, 95% CI0.90-1.52, p=0.25) or lysis of adhesions (HR 0.87, 95% CI 0.50- 1.40), p=0.57). Limitations of the study include the retrospective design and use of administrative claims data. CONCLUSIONS: Relative to open radical prostatectomy, minimally invasive radical prostatectomy is not associated with an increased risk of postoperative small bowel obstruction and lysis of adhesions.