Small bowel obstruction and abdominal pain after robotic versus open radical prostatectomy

Abstract

Objective The aim of this study was to examine whether intraperitoneal robot-assisted surgery leads to small bowel obstruction (SBO), possibly caused by the formation of intra-abdominal adhesions.

Materials and methods In total, 7256 men treated by intraperitoneal robot-assisted radical prostatectomy (RARP) and 9787 men treated by retropubic radical prostatectomy (RRP) in 2005–2012 were identified in the Prostate Cancer data Base Sweden (PCBaSe). Multivariable Cox proportional hazards models were used to calculate the risk of readmission for SBO, SBO-related surgery and admissions due to abdominal pain up to 5 years postoperatively.

Results During the first postoperative year, the risk of readmission for SBO was higher after RARP than after RRP [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.14–3.25] but after 5 years there was no significant difference (HR 1.28, 95% CI 0.86–1.91), and there was no difference in the risk of SBO surgery during any period. The risk of admission for abdominal pain was significantly increased after RARP during the first year (HR 2.24, 95% CI 1.50–3.33) but not after 5 years (HR 1.23, 95% CI 0.92–1.63).

Conclusion Intraperitoneal RARP had an increased risk of SBO and abdominal pain in the short term during the first year, but not in the long term, compared to RRP.

Keywords:

• Adhesions
• intestinal obstruction
• open prostatectomy
• robot-assisted radical prostatectomy
• small bowel obstruction

Acknowledgements

This project was made possible by the continuous work of the National Prostate Cancer Register of Sweden (NPCR) steering group: Pär Stattin (chairman), Anders Widmark, Camilla Thellenberg, Ove Andrén, Anna Bill Axelson, Ann-Sofi Fransson, Magnus Törnblom, Stefan Carlsson, Marie Hjälm-Eriksson, Bodil Westman, Bill Pettersson, David Robinson, Mats Andén, Jan-Erik Damber, Jonas Hugosson, Ingela Franck Lissbrant, Maria Nyberg, Göran Ahlgren, Ola Bratt, René Blom, Rolf Lundgren, Lars Egevad, Calle Walller, Olof Akre, Per Fransson, Eva Johansson, Fredrik Sandin, Hans Garmo, Mats Lambe, Karin Hellström, Annette Wigertz and Erik Holmberg.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding information

The Swedish Research Council and Jämtland County Council funded this study. The Laura and Isaac Perlmutter NYU Cancer Center and the Louis Feil Charitable Lead Trust support SL.