Radical retropubic prostatectomy: time trends, morbidity and mortality in Japan

Objectives To assess the time trends, morbidity and mortality of contempora ry anatomical radical retropubic prostatectomy (RRP) in a multi-institution al study in Japan, where RRP has become more popular in the last decade. Patients and methods Between January 1991 and August 1998, 638 patients und erwent RRP at seven urological centres in Japan. Major complications (withi n 30 days of surgery) and the 30-day mortality were reviewed retrospectivel y. Of the patients, 12.9% were <60 years old, 56.3% were 60-69 years old an d 30.9% were greater than or equal to 70 years old (median age 67). Results The number of RRPs increased markedly, by more than sevenfold, from 1991-92 to 1996-97, mainly because there were more patients undergoing RRP in their sixth decade, The contribution of Tlc disease increased in absolu te and relative terms, from 13.9% in 1991-92 to 37.9% in 1997-98, Over time , the mean blood loss and the allogeneic transfusion rate decreased steadil y. There was a trend toward more favourable outcomes for pathological varia bles (an increased percentage of organ-confined disease, decreased margin p ositivity and a decreased incidence of positive lymph node metastasis), The most common complications were wound-related (7.5%), or anastomotic leakag e (4.1%), Major cardiopulmonary complications occurred in only two patients (0.31%, both pulmonary embolisms). One patient died from cerebral haemorrh age within 30 days of surgery, giving a mortality rate of 0.16%, Conclusions This study indicates a trend towards selecting patients most li kely to benefit from RRP, Although the procedure is technically demanding, it can have an acceptably low rate of early complications, little mortality and need for allogeneic transfusion. The assessment of morbidity suggests a lower incidence of catastrophic thrombo-embolic and cardiac complications in Japanese patients than in Western men. The present data may be useful i n decision-analysis models evaluating the role of therapy for Asian men wit h early-stage prostate cancer.