Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy

PURPOSE: We classified and assessed trends in the incidence, severity and management of perioperative morbidity following laparoscopic radical prostatectomy (LRP). MATERIALS AND METHODS: We retrospectively reviewed the records of 250 patients with clinically localized prostate cancer who underwent transperitoneal LRP, as performed by 2 surgeons (CPP and LMS), between April 2001 and March 2004. The Clavien classification system was used to grade complications for cases completed laparoscopically. RESULTS: In the 246 cases completed laparoscopically 20 grade II, 12 grade III and 2 grade IV complications were noted during a mean followup of 13.7 months (overall complication rate 13.8%). Median hospital stay was 2 days (range 2 to 8) and median duration of bladder catheterization was 10 days (range 3 to 36). Postoperative ileus that prolonged hospital stay was the most frequent complication and it occurred in 8 patients (3.3%). Seven patients required blood transfusion (2.8%). Bladder neck contracture was observed in 3 patients (1.2%). A total of 11 complications occurred in the first 50 cases, while 12, 6, 8 and 1 occurred in cases 51 to 100, 101 to 150, 151 to 200 and 201 to 250, respectively. CONCLUSIONS: Perioperative complications following LRP are mostly self-limited and grade II or III (94.1%). The incidence of complications and need for conversion to open radical prostatectomy decreased with experience. Uniform reporting and grading of surgical complications via a standardized classification system may permit more meaningful comparisons among different centers and surgical techniques.