1347 RISK OF HERNIA COMPLICATIONS AFTER MINIMALLY INVASIVE VERSUS OPEN RADICAL PROSTATECTOMY (2013)

You have accessJournal of UrologyProstate Cancer: Localized (VI)1 Apr 20131347 RISK OF HERNIA COMPLICATIONS AFTER MINIMALLY INVASIVE VERSUS OPEN RADICAL PROSTATECTOMY Sigrid Carlsson, Behfar Ehdaie, Coral Atoria, Elena Elkin, and James Eastham Sigrid CarlssonSigrid Carlsson New York, NY More articles by this author , Behfar EhdaieBehfar Ehdaie New York, NY More articles by this author , Coral AtoriaCoral Atoria New York, NY More articles by this author , Elena ElkinElena Elkin New York, NY More articles by this author , and James EasthamJames Eastham New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.03.058AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Given the sharp rise in the number of radical prostatectomies (RP) performed annually in the US,it is important to quantify the risk of potentially serious complications following surgery. These include hernia formations (incisional, inguinal and umbilical). However, little is known about the impact of RP type on the occurrence of hernias in large population-based settings. The aim of this study was to compare the incidence of post-RP hernia repair after minimally invasive RP (MIRP) versus open retropubic RP (ORP). METHODS In the linked Surveillance,Epidemiology,and End Results(SEER)-Medicare database we identified men >65 years diagnosed with prostate cancer between 2003-2007 who underwent RP. The primary outcome was receipt of a hernia repair procedure any time after RP. We estimated the impact of surgical approach (MIRP vs ORP) on the risk of post-RP hernia repair using multivariable proportional hazards regression, controlling for patient and disease characteristics, including previous hernia repair and surgeon volume. Patient treated with radiotherapy served as a control group. RESULTS We identified 3,193 patients who had MIRP and 6,772 who had ORP. The incidence of post-RP hernia repair was 12.4% for those with MIRP (Md follow-up 3.1 years) versus 10.1% for ORP (Md follow-up 4.3 years). The corresponding rate in the control group was 5.02%. The rates of incisional, umbilical and inguinal hernia repair for MIRP vs. ORP were 4.8% vs. 1.7%, 0.53% vs. 0.46% and 6.4% vs. 7.7%, respectively. MIRP was associated with an increased risk of hernia repair compared with ORP (adjusted hazard ratio (AHR) 1.41, 95% confidence interval, CI, 1.22 - 1.64, p <0.0001), controlling for patient and disease characteristics. Age at surgery, geographical region, clinical T-stage, Gleason score, surgeon volume and previous hernia repair were also significant predictors of post-RP hernia repair (existence of previous hernia repair being the strongest predictor: AHR 1.76,95% CI 1.43–2.16, p<0.0001). When the outcome was limited to incisional repair only, MIRP was associated with a more than three-fold increased risk of repair as compared to ORP (AHR 3.17,95% CI 2.41–4.17, p <0.0001). CONCLUSIONS In this population-based study, we found that MIRP was associated with a significantly increased risk of incisional hernias compared to ORP. This represents a technical issue that warrants attention. Given the increased use of MIRP in the past decade, this complication needs to be taken into consideration in the overall picture of advantages/disadvantages of this surgical modality in patient counseling. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e550 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sigrid Carlsson New York, NY More articles by this author Behfar Ehdaie New York, NY More articles by this author Coral Atoria New York, NY More articles by this author Elena Elkin New York, NY More articles by this author James Eastham New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...