Complications of radical prostatectomy relate to risk stratification of prostate cancer patients

Purpose: To analyze, classified and report a single surgeon experience of perieoperative complications of open radical prostatectomy associated with risk classification of prostate cancer.

Materials and Methods: Between 1984 and 2011, a total of 305 patients receiving open radical prostatectomy were evaluated for surgery related complications. Patients age ranged from 43 to 78 with a mean age of 68.5. Complications were classified into intra-operative, postoperative (<30 days) and late (>30 days). The Modified Claverin system was used to grade complications.

Results: Of 305 patients, 34 (11.2 %) had record of surgery related complications those including: 9 (2.7 %) intra-operative recognized, 19 (6.1%) postoperative and 7 (2.3) happened post discharge complications. Intra-operative complications were all grade 3 (All 7 rectum injury were recognized in operation and 6 of them were resolved by simple two layers sutures and another one had proximal colon diversion. Intra-operative bleeding was also analyzed. The mean blood loss was calculated as 1214 ml for first 100 cases, 960 ml for 2^nd 100 cases and 880 ml for recent 105 cases, The blood transfusion rate were 76 %, 65 % and 57 % respectively. Of 34 complications, 5 (1.7%) were Clavein grade 1, 9 (2.9%) were grade 2, 16 (5.2%) were grade 3 and one grade 4.One grade V (Mortality). Major complications (grade3/4) occurred in 10 % in first 100 cases and 80% of them were high risk patients. However major complications happened in 3.8% in recent 105 cases and all of them were high risk patients.

Conclusion: Radical prostatectomy is associated with major complications rate of 5.9 %. Almost of these complications were correctable if detected early, The operation mortality was 0.3%. Major complications are voluntary occurred in high risk patients suggest extended node dissection with wider excision of peri-prostate tissue may responsible for higher complications.