Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis

Author:

Wani Mudassir1ORCID,Al-Mitwalli Abdullah1,Mukherjee Subhabrata2,Nabi Ghulam3,Somani Bhaskar4ORCID,Abbaraju Jayasimha5,Madaan Sanjeev5ORCID

Affiliation:

1. Department of Urology, Swansea Bay University Health Board, Swansea SA6 6NL, UK

2. Department of Urology, Imperial College Healthcare NHS Trust, London W6 8RF, UK

3. School of Medicine, Centre for Medical Engineering and Technology, University of Dundee, Dundee DD1 9SY, UK

4. Urological Surgery Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK

5. Department of Urology & Nephrology, Dartford, and Gravesham NHS Trust, Dartford DA2 8DA, UK

Abstract

Radical prostatectomy (RP) is one of the recommended treatments to achieve oncological outcomes in localized prostate cancer. However, a radical prostatectomy is a major abdominopelvic surgery. Venous thromboembolism (VTE) is a well-known complication associated with surgical procedures, including RP. There is a lack of consensus regarding VTE prophylaxis in urological procedures. The aim of this systematic review and meta-analysis was to investigate different aspects of VTE in post-radical prostatectomy patients. A comprehensive literature search was performed, and relevant data were extracted. The primary aim was to perform a systematic review and meta-analysis (wherever possible) of VTE occurrence in post-RP patients in relation to surgical approach, pelvic lymph node dissection, and type of prophylaxis (mechanical or combined prophylaxis). The secondary aim was to investigate the incidence and other risk factors of VTE in post-RP patients. A total of 16 studies were included for quantitative analysis. Statistical methods for analysis included the DerSimonian–Laird random effects. We were able to conclude that the overall incidence of VTE in post-radical prostatectomy is 1% (95% CI) and minimally invasive procedures (MIS), including laparoscopic, as well as robotic procedures for radical prostatectomy and RP without pelvic lymph node dissection (PLND), are associated with less risk of developing VTE. Additional pharmacological prophylaxis to mechanical methods may not be necessary in all cases and should be considered in high-risk patients only.

Publisher

MDPI AG

Subject

General Medicine

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