Pelvic lymph-node dissections in bladder and prostate cancer surgery and the risk of postoperative venous thromboembolism

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INTRODUCTION: To evaluate the risk of venous thromboembolic events in patients operated with radical cystectomy or radical prostatectomy and pelvic lymph-node dissection. MATERIAL AND METHODS: Patients operated with radical cystectomy for bladder cancer or with radical prostatectomy for prostate cancer from 1997 through 2016 were identified from Swedish nationwide registers. We estimated odds ratios of association between lymph-node dissection and pulmonary embolism and deep venous thrombosis (DVT) using logistic regression adjusted for the probability of having lymph-node dissection. RESULTS: In total, 6069 patients operated with radical cystectomy and 36 911 patients with radical prostatectomy were included. The risk of pulmonary embolism and DVT after radical cystectomy with lymph-node dissection was 1,89 % and 2,29 %, and without lymph-node dissection 1,99 % and 2,35 %, respectively. After radical prostatectomy and lymph-node dissection the risk for pulmonary embolism and DVT were 0,97 % and 1,36 %, and without lymph-node dissection 0,42 % and 0,49 %, respectively. Pelvic lymph-node dissection during a radical cystectomy was not associated with pulmonary embolism (OR 0,99; 95 % CI 0,65-1,51) or DVT (OR 0,99; 95 % CI 0,68-1,48), whereas lymph-node dissection during radical prostatectomy was associated with higher odds of both pulmonary embolism (OR 2,29; 95 % CI 1,67-3,09) and DVT (OR 2,95; 95 % CI 2,27-3,85). CONCLUSION: Pelvic lymph-node dissection did not increase the risk of venous thromboembolism after a cystectomy, whereas we found an increased relative risk of venous thromboembolic events associated with radical prostatectomy with lymph-node dissection.

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