Bony pelvis structures in the CT don't affect the perioperative outcomes of Radical Prostatectomy

Bony pelvic characteristics in Computed tomography (CT) might not have a big impact on how open radical prostatectomy (RP) goes postoperatively, says an article published in Prostate International Journal.

The second most frequently diagnosed cancer in males and the fifth most prevalent cause of death worldwide is prostate cancer. Radical prostatectomy is the recommended course of therapy for the majority of individuals with clinically localized prostate cancer. The goal of the study by Serdar Kalemci and colleagues was to assess the predictive value of computerized tomography (CT) measurements of the bony pelvic parameters for use in the prediction of potential technical challenges that might arise during open radical prostatectomy for localized prostate cancer.

For this study, between October 2016 and November 2018, 100 patients undergoing open RP for localized prostate cancer were assessed. The same skilled surgeon carried out each procedure. Spiral CT scans were used to quantify pelvic parameters. Data were retrospectively gathered and evaluated from medical, surgical, radiological, and pathology records. Indicators of operative difficulties were positive surgical margin (PSM), the presence of vesicourethral anastomosis stricture (VUAS) and urine leakage, operating time, urethral catheterization time, and anticipated blood loss. Both univariate and multivariate analyses were carried out in order to ascertain the relevance of these factors.

The main findings of this study were:

1. The patients' pelvic characteristics did not significantly correlate with the existence of PSM, VUAS, or urine leakage.

2. Patients with PSM had increased PSA levels and pathological tumor stages alone.

3. None of the individual pelvic measures evaluated on a univariate or multivariate basis had a statistically significant correlation with the duration of the procedure, the anticipated blood loss, or the duration of the urethral catheterization.

4. The pathological tumor stage, surgery time, and PSA levels all significantly correlated in univariate analysis.

In conclusion, it could be required to alter how the operation is carried out in patients with locally advanced illness and a challenging pelvic anatomy in order to have better results. In order to obtain more accurate results, studies involving larger sample sizes and carefully constructed control groups are required. Additionally, a particular predictor of the complexity of pelvic dissection may be helpful in determining if to perform the RP open, robot-assisted or laparoscopic approach.

Reference: 

Kalemci, S., Ergun, K. E., Kizilay, F., Akyol, A., & Simsir, A. (2022). Do bony pelvis parameters affect perioperative outcomes in open radical prostatectomy? In Prostate International (Vol. 10, Issue 3, pp. 129–134). Elsevier BV. https://doi.org/10.1016/j.prnil.2022.05.002