To assess the association between blood loss, blood transfusion (BT) and biochemical recurrence (BCR)-free, metastasis-free and overall survival after radical prostatectomy (RP) in a large single-center cohort of patients. Perioperative BT at oncologic surgery has been reported to be a potential risk factor for cancer recurrence and survival in several cancer entities. Current studies addressing the relationship between BT, blood loss and BCR-free survival in prostate cancer patients are controversial and include only series with fairly small patient cohorts.

Background: To assess the rates of red blood cell (RBC) transfusions, pelvic lymphoceles, and prolonged drainage duration in patients after radical prostatectomy (RP) receiving perioperative bridging with low-molecular-weight heparin (LMWH).Patients and methods: Between 2006 and 2009, 114 RP patients receiving bridging therapy with 60 mg (n = 63) or >= 80 mg (a = 51) Enoxaparin/d were compared to 1327 consecutive RP patients receiving 40 mg Enoxaparin/d. Logistic regression models were used to test the effect of LMWH dosage on all three outcomes. Covariables included age, body mass index (BMI), Charlson comorbidity index (CO), prostate volume, pelvic lymph node dissection, and pathological stage.Results: The RBC transfusion rates in patients treated with 40, 60 and >= 80 mg were 4.9, 9.5 and 19.6%, respectively (p < 0.001). The respective lymphocele rates were 6.4, 3.2 and 2.0% (p = 0.26). The respective rates of drainage duration of >= 4 days were 6.7, 4.8 and 16.7% (p = 0.088). After adjusting for confounding factors, patients receiving >= 80 mg were 4.1-fold more likely to be transfused than patients receiving prophylactic LMWH (p = 0.02). Similarly, patients receiving >= 80 mg were 3.2-fold more likely to have a drainage duration of >= 4 days than patients receiving prophylactic LMWH (p = 0.03).Conclusions: Patients with a perioperative bridging with LMWH in RP are more likely to receive a RBC transfusion and to have prolonged drainage duration. Conversely, bridging therapy was not associated with an increased risk of lymphocele formation. (c) 2012 Elsevier Ltd. All rights reserved.

Background: The 2011 European Association of Urology (EAU) guidelines for prostate cancer recommend a pelvic lymph node dissection (PLND) at radical prostatectomy (RP) in all individuals with a nomogram predicted lymph node invasion (LNI) risk of >7%.Methods: To test the performing characteristics for several thresholds (1-14%) and to examine the overall accuracy and calibration plot of the EAU nomogram at our institution. The study population consisted of 3081 patients treated with RP and PLND limited to the obturator fossa and the external iliac vein between 2008 and 2010 at a single European institution from Germany. More extensive PLNDs were performed at the surgeon's discretion.Results: Overall, 260 patients (9.2%) had LNI. The 7% threshold would have avoided 30% of PLNDs, at the cost of missing 8% of patients with LNI. The use of 8% and 9% threshold would have allowed the avoidance of respectively 39% and 48% of PLNDs, at the cost of missing respectively 12% and 14% of patients with LNI. The accuracy of the LNI nomogram was 78%, and the unadjusted departure from ideal calibration was 5.3%.Conclusions: We confirmed adequate accuracy and calibration of the LNI nomogram. The 7% cut-off may be overly conservative. Better trade-offs between avoided PLNDs and missed LNI cases may be achieved with a limit of 8 or even 9%. (c) 2012 Elsevier Ltd. All rights reserved.

You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2012375 FROZEN SECTION NAVIGATED RADICAL PROSTATECTOMY SIGNIFICANTLY INCREASE THE FREQUENCY OF NERVE-SPARING WITHOUT COMPROMISING ONCOLOGICAL OUTCOME Thorsten Schlomm, Pierre Tennstedt, Caroline Huxold, Lars Budäus, Thomas Steuber, Alexander Haese, Georg Salomon, Guido Sauter, Sarah Minner, Hartwig Huland, and Markus Graefen Thorsten SchlommThorsten Schlomm Hamburg, Germany More articles by this author , Pierre TennstedtPierre Tennstedt Hamburg, Germany More articles by this author , Caroline HuxoldCaroline Huxold Hamburg, Germany More articles by this author , Lars BudäusLars Budäus Hamburg, Germany More articles by this author , Thomas SteuberThomas Steuber Hamburg, Germany More articles by this author , Alexander HaeseAlexander Haese Hamburg, Germany More articles by this author , Georg SalomonGeorg Salomon Hamburg, Germany More articles by this author , Guido SauterGuido Sauter Hamburg, Germany More articles by this author , Sarah MinnerSarah Minner Hamburg, Germany More articles by this author , Hartwig HulandHartwig Huland Hamburg, Germany More articles by this author , and Markus GraefenMarkus Graefen Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.438AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative frozen section (IFS) diagnosis is widely used in surgical oncology for intraoperative histological assessment of surgical margins, but still controversially discussed in the surgical treatment of prostate cancer. In our study, we evaluated the clinical impact of IFS-navigated nerve-sparing in a large single institution radical prostatectomy (RP) series. METHODS We analyzed 11,219 consecutive patients who underwent RP between 2002 and 2011 in our center. IFS were performed in 5,499 patients (4,173 bilateral, 1,326 unilateral), including the whole latero-rectal surface of the prostate corresponding to the preserved neurovascular bundle (NVB). In 1371 patients a secondary NVB resection (1,278 unilateral, 93 bilateral) was performed on the basis of a positive IFS result. Adjustment of confounding bias in this non-randomized patient cohort was applied by propensity score based analysis using standard postoperative clinico-pathological variables (pT-stage, pN, Gleason score, and PSA). The impact of FS on the frequency of nerve-sparing (NS), surgical margin (SM)-status, and biochemical recurrence (BCR) was analyzed by chi2-likelyhood test, Kaplan Meier analyses, and multivariate cox regression analyses. RESULTS In IFS RPs, the rate of NS was significantly higher (overall 96.9% vs. 85.0%; pT2, 99.1% vs. 94.6%; pT3a, 94.1% vs. 77.6%; pT3b, 90.0% vs. 46.0%) and the rate of +SM was significantly lower (overall 14.2% vs. 21.8%; pT2, 7.8% vs. 13.1%; pT3a, 18.8% vs. 32.3%; pT3b, 41.2% vs. 50.8%) as compared with the matched non-IFS RPs (p<0.0001, each). In a multivariable cox regression model of the entire cohort of 11,219 patients, including pT-stage, Gleason score, preoperative PSA, and SMS, neither IFS status nor secondary NVB resection were independent predictors of BCR-free survival (p=0.57 and p=0.14, respectively). Of the 1.371 secondary resected NVBs, 370 (27.0%) contained tumor tissue. In multivariate cox regression model, the length and predominant Gleason pattern of the positive surgical FS margin correlated significantly with the presence of tumor tissue in the secondary resected NVB (p<0.0001, each). CONCLUSIONS Intraoperative frozen section navigated radical prostatectomy results in an increased rate of nerve-sparing and decreased rate of positive surgical margins without compromising oncological outcome. Our results strongly argue towards a systematic application of intraoperative whole latero-rectal surface frozen sections in nerve-sparing radical prostatectomy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e153-e154 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thorsten Schlomm Hamburg, Germany More articles by this author Pierre Tennstedt Hamburg, Germany More articles by this author Caroline Huxold Hamburg, Germany More articles by this author Lars Budäus Hamburg, Germany More articles by this author Thomas Steuber Hamburg, Germany More articles by this author Alexander Haese Hamburg, Germany More articles by this author Georg Salomon Hamburg, Germany More articles by this author Guido Sauter Hamburg, Germany More articles by this author Sarah Minner Hamburg, Germany More articles by this author Hartwig Huland Hamburg, Germany More articles by this author Markus Graefen Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20121342 RELATIONSHIP BETWEEN BLOOD LOSS, BLOOD TRANSFUSION AND BIOCHEMICAL RECURRENCE- RATES: ASSESSMENT OF 17347 RADICAL PROSTATECTOMY PATIENTS Katharina Boehm, Lars Budaeus, Pierre Tennstedt, Kristin Kuehne, Hans Heinzer, and Georg Salomon Katharina BoehmKatharina Boehm Hamburg, Germany More articles by this author , Lars BudaeusLars Budaeus Hamburg, Germany More articles by this author , Pierre TennstedtPierre Tennstedt Hamburg, Germany More articles by this author , Kristin KuehneKristin Kuehne Hamburg, Germany More articles by this author , Hans HeinzerHans Heinzer Hamburg, Germany More articles by this author , and Georg SalomonGeorg Salomon Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1724AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Population based studies detected a significant relationship between blood loss and biochemical recurrence (BCR) rate even after adjustment for tumor characteristics. This phenomenon may be related to transfusion related immunosuppression. Aim: To test the association between blood loss, blood transfusion and BCR rate after radical prostatectomy (RP) in a large single center cohort of patients. METHODS Overall 17347 patients who underwent a RP between 01/1992 to 08/2011 were analysed. Cox regression analysis, including PSA level, pT-Stage, lymph node metastasis, Gleason score, margin status, blood loss, transfusion rate (allogeneic or autologous), tested the relationship between blood loss, transfusion and BCR. BCR rate was defined as > 0.2 ng/ml. RESULTS RP was performed by high and low volume surgeons. Mean median blood loss in the transfusion group was 1200 ml and in the non-transfusion group 650 ml. Transfusion rate was 8.8%. BCR rate was 11.6% after a median follow up of 36.6 month. In multivariate analysis PSA level, pT-stage, Gleason-score, margin status and lymph node status achieved an independent predictor status of BCR. No statistically significant relationship between blood loss and BCR or transfusion and BCR exists. CONCLUSIONS This analysis reveals no correlation between blood loss, transfusion and BCR. Therefore, the association between larger blood loss and BCR or transfusion and BCR, described in other surgical treated tumor entities, seems to be irrelevant in prostate cancer patients. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e544-e545 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katharina Boehm Hamburg, Germany More articles by this author Lars Budaeus Hamburg, Germany More articles by this author Pierre Tennstedt Hamburg, Germany More articles by this author Kristin Kuehne Hamburg, Germany More articles by this author Hans Heinzer Hamburg, Germany More articles by this author Georg Salomon Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Background: On average, patients remain hospitalized no more than 2 days after MIRP. The aim of our study was to examine the temporal trends in length of stay >= 3 days and to test the relationship between annual surgical volume (ASV) and annual hospital volume (AHV) and length of stay >= 3 days in patients undergoing MIRP.Material and methods: Within the Florida Hospital Inpatient Datafile, 2439 men who were treated with MIRP for prostate cancer between 2005 and 2008 were identified. Temporal trends were assessed and uni and multi-variable logistic regression models tested the relationship between ASV, AHV and length of stay >= 3 days.Results: The average length of stay decreased from 2.4 in 2005 to 1.7 days in 2008. Length of stay >= 3 days was recorded in 13.6% of patients and the proportion of patients staying more than >= 3 days decreased over time (25.5-12.2%; Chi Square trend p < 0.001). After stratification into low (<1--15 MIRPs) vs. intermediate (16-63 MIRPs) vs. high ASV tertiles (>= 64 MIRPs) the proportion of patients with length of stay >= 3 days were 29.1; 13.2 and 11.1%. In multivariable logistic regression models predicting length of stay >= 3 days, ASV, year of surgery and comorbidities achieved independent predictor status and MIRP patients operated by highest ASV tertile surgeons were 71% (p < 0.001) less likely to be hospitalized for more than 3 days.Conclusion: The length of stay after MIRP decreased between 2005 and 2008. Surgical expertise represented one of the main determinants of shorter length of stay. (c) 2011 Published by Elsevier Ltd.