Introduction

The aim of this study was to identify factors associated with post-operative complications after robotic-assisted radical prostatectomy (RARP) in contemporary patients and to assess the probability of freedom from relevant complications according to surgical expertise

Methods

1,214 patients treated with RARP by 4 high-volume surgeons at a single referral centre between 2006 and 2015. All surgeons had a previous high-volume experience with open RP (at least 200 cases). Surgical expertise was coded as the progressive number of procedure done by each surgeon, starting from the first robotic case. Multivariable logistic regression analyses (MVA) were used to predict 90-day relevant complications (Clavien Dindo system 2-5) which were prospectively recorded for all men. Covariates consisted of age at surgery, Charlson comorbidity index, D'Amico risk groups, number of nodes removed, intra-operative time and log-transformed surgical expertise. A locally weighted, scatterplot smoothing method was used to graphically assess the multivariable effect of surgical expertise on the probability of complications

Results

Overall, 245 (20.2%) patients experienced post-op complications, of which 13.8 and 8.1% were graded 2-5 and 3-5, respectively. The most common complications were lymphoceles (8.5%), blood transfusions (4.4%), fever requiring antibiotics (4.2%), anastomosis leakage (3.5%), pelvic hematoma (2.8%), post-surgical hernia (2.1%) and urinary retention (1.2%). Overall, 4.7% of patients with lymphoceles required percutaneous drainage, 1.1% with pelvic hematoma and 1.2% with post-surgical hernia required reoperation. There were 4 (0.2%) admissions to intensive care units for cardiac events (Clavien IVa). At MVA, surgical expertise (OR: 0.8; p=0.01) and number of nodes removed (OR: 1.03; p=0.005) were independent predictors of 90-day complications. Figure 1 a-b represents the inverse association between surgical expertise and complications after RARP which was maintained across all risk groups

Conclusions

Among contemporary patients, the rate of complications related to RARP is not negligible. Surgical expertise is the major determinant of decreased risk of postoperative complications, regardless of disease characteristics

Funding

none