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Komplikationen bei radikalen retropubischen Prostatektomien anhand der Martin-Kriterien

Complications of radical retropubic prostatectomies based on the Martin criteria

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Zusammenfassung

Hintergrund

2002 definierten Martin et al. 10 Kriterien für eine qualitativ hochwertige Berichterstattung über Komplikationen nach operativen Eingriffen. Nur wenige Publikationen zu Komplikationen nach radikaler retropubischer Prostatektomie erfüllen diese Kriterien.

Patienten und Methode

Zwischen 08/2003 und 06/2010 wurde bei 3172 Patienten mit klinisch lokalisiertem Prostatakarzinom die offene retropubische radikale Prostatektomie durchgeführt. Alle medizinischen und chirurgischen Komplikationen, die sich während des stationären Aufenthalts bis 30 Tage postoperativ ereigneten, wurden retrospektiv nach der Clavien-Dindo-Klassifikation eingeteilt. Potentielle klinische, laborchemische und histopathologische Risikofaktoren für Komplikationen wurden statistisch evaluiert. Alle 10 Martin-Kriterien für eine hochwertige Berichterstattung nach Operationen sind erfüllt.

Ergebnisse

Die Gesamtkomplikationsrate betrug 28,6%. Bei 907 Patienten traten 1069 Komplikationen auf. Davon waren 909 niedriggradige (Grad I–II) und 160 höhergradige (Grad III–V) Komplikationen. 731 Patienten hatten ausschließlich niedriggradige und 89 Patienten ausschließlich höhergradige Komplikationen. Die Mortalität betrug 0,1% (n=4). Höheres Alter [p=0,023; relatives Risiko (RR) 1,049] und eine durchgeführte Lymphadenektomie (p=0,024; RR=1,804) waren in der multivariaten Analyse unabhängige Risikofaktoren für höhergradige Komplikationen.

Schlussfolgerung

Bei der Verwendung eines standardisierten Systems zur Erfassung von postoperativen Komplikationen nach radikaler retropubischer Prostatektomie beobachtet man eine Gesamtkomplikationsrate von 28,6%, wobei die Mehrheit klinisch von geringer Bedeutung ist (85%, Grad-I- bis -II-Komplikationen). Höheres Alter ist ein unabhängiger Risikofaktor für Komplikationen (Grad I–V) nach radikaler Prostatektomie und bleibt somit ein wichtiger Faktor für die Indikationsstellung zur chirurgischen Therapie.

Abstract

Background

In 2002 the ten Martin criteria were proposed which should be met when reporting complications following surgery. Only a few studies have evaluated complication rates after open retropubic radical prostatectomy using these criteria. In this study we report on complications of open retropubic radical prostatectomy using the standardized Clavien-Dindo reporting methodology.

Patients and methods

The overall complication rate was 28.6% (907 of 3,172). We registered 1,069 medical or surgical complications in 907 patients. Of these, 714 complications were grade I (66.8%), 195 grade II (18.2%), 139 grade III (13%), and 17 grade IV (1.6%), respectively. The mortality rate (grade V) was 0.1% (4 of 3,172). Older age (hazard ratio 1.049, p=0.023) and a performed lymphadenectomy (hazard ratio 1.804, p=0.024) were independent predictors for high-grade complications (grade III or greater) on multivariate analysis.

Results

Between 08/2003 and 06/2010 complications of 3172 consecutive men who underwent open retropubic radical prostatectomy at a single center were recorded prospectively. Complications which occurred within a period of 30 days postoperatively were graded retrospectively according to the Clavien-Dindo classification. Clinical and histopathological risk factors were statistically evaluated for an association with complication grades. All 10 Martin criteria were fulfilled.

Conclusions

Using the Clavien-Dindo classification as a standardized reporting methodology, we observed an acceptable overall complication rate of 28.6%. In the majority (85% of all complications) lower grade complications occurred. In this series older age and a lymphadenectomy were risk factors for high-grade complications (III-V). A patient’s age remains an important factor when considering the indication for radical prostatectomy.

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Correspondence to B. Löppenberg.

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Löppenberg, B., Noldus, J. & Palisaar, J. Komplikationen bei radikalen retropubischen Prostatektomien anhand der Martin-Kriterien. Urologe 50, 1403–1411 (2011). https://doi.org/10.1007/s00120-011-2603-x

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Schlüsselwörter

  • Prostatakarzinom
  • Radikale Prostatektomie
  • Martin-Kriterien
  • Komplikationen
  • Standards

Keywords

  • Postoperative complications
  • Prostatectomy
  • Martin criteria
  • Prostatic neoplasms
  • Reference standards