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Hospital readmissions after limited vs. extended lymph node dissection during open and robot-assisted radical prostatectomy

Journal article
Authors Stavros I. Tyritzis
Ulrica Wilderäng
Αnna Wallerstedt Lantz
Gunnar Steineck
Jonas Hugosson
Anders Bjartell
Johan Stranne
Eva Haglind
Nils Peter Wiklund
Published in Urologic Oncology: Seminars and Original Investigations
Volume 38
Issue 1
Pages 5e1-5e8
ISSN 1078-1439
Publication year 2020
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Oncology
Institute of Clinical Sciences, Department of Urology
Pages 5e1-5e8
Language en
Keywords Complications, Extended, Limited, Lymph node dissection, Open, Radical prostatectomy, Robot-assisted
Subject categories Urology and Nephrology, Cancer and Oncology


© 2019 Elsevier Inc. Purpose: Differences exist concerning when and how to perform lymph node dissection (LND) during radical prostatectomy due to lack of high-grade evidence to its safety and efficacy. We aimed to compare readmission rates between limited and extended LND during open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP). Materials and methods: We conducted a prospective trial of 3,706 eligible patients comparing ORP vs. RARP (LAPPRO). Six hundred and twenty-seven underwent concomitant LND. Data were retrieved for readmissions within 90 days from surgery from the Swedish Patient Registry. Causes for readmissions were classified according to the modified Clavien-Dindo classification system. We estimated risks for readmission stratified by type of LND and surgical approach. Results: We recorded 107 readmissions in 90 patients. The overall readmission rate was 14% (90/627). In the open group, extended LND had a higher, but not statistically significant readmission rate of 18% compared to 11% after limited LND (95%CI 0.87–3.01). In the robot-assisted group, readmissions after extended LND did not differ from limited LND (15% vs. 18%, 95%CI 0.49–1.61). RARP with limited LND showed a higher risk for any (RR 1.98, 95%CI [1.02–3.81]) as well as Clavien-Dindo grade 1 to 2 readmissions (RR 2.49, 95%CI [1.10–5.63]) compared to open approach with limited LND. Robot-assisted extended LND reduced the risk for Clavien-Dindo grade 3 to 5 complications leading to readmissions compared to the open approach by 59% (RR 0.41, 95%CI [0.19-0.87]). Conclusions: The risk for hospital readmission was similar when performing limited or extended LND during a radical prostatectomy. Robot-assisted technique for performing extended LND may decrease the risk for severe complications.

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