Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Material and Methods
2.1. Protocol and Registration
2.2. Evidence Acquisition
- Population: male patients, prostatectomy for prostate cancer;
- Intervention: pharmacological/combined prophylaxis (PP) for VTE;
- Comparator/control: no prophylaxis or mechanical prophylaxis for VTE.
- Population: prostatectomy for non-prostate cancer or part of other surgery, such as cystoprostatectomy.
- Intervention: if the interventions are ill-defined or structural methods are inadequate;
- Comparator/control: studies that lacked proper grouping into control, and intervention;
- Study design: studies that did not fulfill the above criterion and lacked any defined outcomes.
2.3. Outcome Measures
- Primary outcomes: VTE occurrence with
- Overall incidence of VTE in post-RP Patients;
- Surgical approach: open, minimally invasive (laparoscopic or robot-assisted laparoscopic prostatectomy);
- Pelvic lymph node dissection (PLND);
- Prophylaxis (no prophylaxis, mechanical only, pharmacological only, combined).
- Secondary outcomes:
2.4. Search Methods
2.5. Study Selection
2.6. Data Extraction
2.7. Quality Assessment
2.8. Statistical Analysis
- a
- Statistical evaluation of overall VTE occurrence.
- b
- Statistical evaluation of VTE occurrence depending on the type of surgical procedure (Open/Minimally Invasive Surgery (MIS)) and whether PLND was performed or not.
- MIS procedures vs. open procedures;
- Procedures using PLND vs. procedures without PLND.
- c
- Statistical Evaluation of VTE occurrence depending on the method of prophylaxis used (mechanical or combined).
3. Results
3.1. Study Selection Results
3.2. Quality Assessment Results
3.3. Study Characteristics
3.4. Clinical-Pathological Results
3.5. Demographics and VTE Risk Factors
3.6. Surgical Procedure Results
3.7. Thromboprophylaxis and VTE Episodes
3.8. Surgical Approaches and VTE Episodes
3.9. Duration and Timing of Thromboprophylaxis
3.10. Statistical Results
- a
- Statistical outcome of overall VTE occurrence
- b
- Statistical outcome of VTE occurrence depending on the type of surgical procedure (Open/MIS) and whether PLND was performed or not.
- c
- Statistical outcome of VTE occurrence depending on the method of prophylaxis used (mechanical or combined).
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Author | Number of Awarded Stars in Each Domain | ||
---|---|---|---|
Selection | Comparability | Outcome | |
(1) Patel, H. D. [17] | **** | ** | ** |
(2) Valverde-Martinez, S. [18] | *** | * | ** |
(3) Weinberg, A. [14] | *** | ** | |
(4) Tollefson, M. K. [19] | *** | ** | |
(5) Chan, S. [20] | ** | ** | |
(6) Chalmers, D. J. [21] | *** | ** | |
(7) Abel, E. [22] | *** | ** | |
(8) Dyer, J. [23] | ** | * | |
(9) Van Hemelrijck, M. [24] | ** | ** | |
(10) Eifler, J. B. [25] | ** | ** | |
(11) Beyer, J. [26] | *** | ** | |
(12) Grasso, M. [27] | ** | * | |
(13) Cindolo, L. [28] | ** | * | |
(14) Nakamura, K. [29] | ** | * | |
(15)Koya, M. [30] | *** | * | |
(16) Cisek, L. [31] | ** | * |
Study | Study Type/ Time | Study Characteristics | Conclusion |
---|---|---|---|
(1) Patel, H. D. [17] | RCT (2017–2018) |
|
|
(2) Valverde-Martinez, S. [18] | Retrospective (2013–2014) |
|
|
(3) Weinberg, A. [14] | Observational (2000–2010) |
|
|
(4) Tollefson, M. K. [19] | Retrospective (1987–2010) |
|
|
(5) Chan, S.Y. [20] | Prospective (2007–2010) |
|
|
(6) Chalmers, D. J. [21] | Prospective (2007–2011) |
|
|
(7) Abel, E. [22] | Retrospective (2007–2011) |
|
|
(8) Dyer, J. [23] | Retrospective (2009–2010) |
|
|
(9) Van Hemelrijck, M. [24] | Retrospective (2002–2010) |
|
|
(10) Eifler, J. B. [25] | Retrospective (2001–2009) |
|
|
(11) Beyer, J. [26] | Prospective (2001–2003) |
|
|
(12) Grasso, M. [27] | Retrospective (1999–2006) |
|
|
(13) Cindolo, L. [28] | Prospective (2004–2006) |
|
|
(14) Nakamura, K. [29] | Prospective (2003–2005) |
|
|
(15) Koya, M. [30] | Prospective (1992–2004) |
|
|
(16) Cisek, L. [31] | Prospective (1982–1993) |
|
|
Study | Total Patients | Mean Age | Mean BMI kg/m2 | Family History (%) | VTE Background (%) | Smoking | Overall Risk Assessment (in %) | Caprini Score | Remarks in Relation to VTE Risk Factors/Scores | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Low | Int | High | |||||||||
(1) Patel, H. D. [17] | 501 | 62 | 27.4 | - | - | - | - | - | - | 6 | The study concluded that most patients with prostate cancer undergoing RP are relatively healthy. Our study suggests that PP may be deferred based on surgeon preference up to a Caprini score of 7; PP may be justified for higher-risk patients with scores of 8. |
(2) Valverde-Martinez, S. [18] | 610 | 64.1 | 28.03 | - | - | - | 94.8 | 4.1 | 1.1 | - | This study concluded that with respect to the PP used in different thromboembolic risk groups, there were differences in the low-risk group, but not in the intermediate and high-risk groups; this was probably due to the fact that this group covered 95% of the cases in the series. |
(3) Weinberg, A. [14] | 94,709 | - | - | - | - | - | - | - | - | - | - |
(4) Tollefson, M. K. [19] | 18,472 | 63 | 27.7 | - | - | - | - | - | - | - | They concluded that patients with VTE were significantly older than those not diagnosed with VTE (median age 65 vs. 63 years, p < 0.001). |
(5) Chan, S.Y. [20] | 109 | 65.7 | <23 (33) >23 (67) | - | - | 18.1 | - | - | - | - | This study concluded that there was no difference in the incidence of DVT between patients with a history of smoking or diabetes or a high body mass (BMI) index and those without. |
(6) Chalmers, D. J. [21] | 1486 | 59.9 | 28.1 | - | - | - | - | - | - | - | In this study, BMI was not found to be associated with VTE. |
(7) Abel, E. [22] | 549 | 59.8 | - | - | 1.6 | 43.8 | - | A 5-point increase in body mass index was associated with an increased risk of VTEs (odds ratios of 2.0). | |||
(8)Dyer, J. [23] | 3213 | 72.5 | - | - | - | - | - | - | - | - | - |
(9) Van Hemelrijck, M. [24] | 16,304 | - | - | - | 0.6 | - | - | - | - | - | A previous history of VTE is a risk factor in patients undergoing RP. |
(10)Eifler, J. B. [25] | 773 | 57.8 | 27.3 | - | - | - | - | - | - | - | A high incidence of VTE was found in patients with BMI in the top quartile who concomitantly underwent PLND. |
(11) Beyer, J. [26] | 411 | 65.0 | 27.0 | 4.0 | 4.8 | - | - | - | - | A statistically higher risk was found in patients with a personal history of VTE; however, family history was not found with increased risk. | |
(12) Grasso, M. [27] | 500 | 65.0 | - | - | - | - | - | - | - | - | - |
(13) Cindolo, L. [28] | 184 | 69.0 | >25 (30%) | - | - | 28 | - | - | - | - | - |
(14) Nakamura, K. [29] | 47 | 64.0 | - | - | - | - | - | - | - | - | - |
(15)Koya, M. [30] | 1364 | 60.8 | - | - | - | - | - | - | - | - | - |
(16) Cisek, L. [31] | 1300 | - | - | - | - | - | - | - | - | - | - |
Study | Total Procedures | Open | Laparoscopic | Robotic | Unknown | PLND (%) |
---|---|---|---|---|---|---|
(1) Patel, H. D. [17] | 501 | 124 | - | 377 | - | 83.5 (419) |
(2) Valverde-Martinez, S. [18] | 610 | 268 | 311 | 31 | - | - |
(3) Weinberg, A. [14] | 94,709 | 68,244 | - | 26,465 | - | - |
(4) Tollefson, M. K. [19] | 18,472 | 16,374 | - | 2098 | - | 100 |
(5) Chan, S. [20] | 109 | - | - | 109 | - | 33.94 (37) |
(6) Chalmers, D. J. [21] | 1486 | - | - | 1486 | - | 55 |
(7) Abel, E. [22] | 549 | - | - | 549 | - | 12.9 (71/549) |
(8) Dyer, J. [23] | 3213 | - | - | - | 3213 | - |
(9) Van Hemelrijck, M. [24] | 16,304 | 11,137 | - | 5167 | - | 21.6 (3258/16,304) |
(10) Eifler, J. B. [25] | 770 | - | 770 | - | - | 60.8 (468/770) |
(11) Beyer, J. [26] | 411 | 411 | - | - | - | 100 |
(12) Grasso, M. [27] | 500 | 500 | - | - | - | - |
(13) Cindolo, L. [28] | 184 | 184 | - | - | - | 100 |
(14) Nakamura, K. [29] | 47 | 47 | - | - | - | 87 (41/47) |
(15)Koya, M. [30] | 1373 | 1373 | - | - | - | 67 (920/1373) |
(16) Cisek, L. [31] | 1300 | 1300 | - | - | - | - |
Total | 140,541 | 100,088 (71.21%) | 1084 (0.77%) | 36,156 (25.72%) | 3213 (2.28%) | 33.82% (6229/18,417) |
Thromboprophylaxis | VTE Symptomatic Episodes (in %) | |||||||
---|---|---|---|---|---|---|---|---|
N | M | P | C | N | M | P | C | |
(1) Patel, H. D. [17] | - | 250 | - | 251 | - | 2.0 | - | 0.8 |
(2) Valverde-Martinez, S. [18] | 94 | 25 | 516 | 21 | 2.5 | |||
(3) Weinberg, A. [14] | 20,438 | 35,591 | 4945 | 7720 | 0.25 | |||
(4) Tollefson, M. K. [19] | - | - | - | 18,472 | 1.47 | |||
(5) Chan, S. [20] | - | 109 | - | - | 0.09 | |||
(6) Chalmers, D. J. [21] | - | 564 | - | 922 | - | 1.0 | - | 0.7 |
(7) Abel, E. [22] | - | 540 | - | 9 | 1.8 | |||
(8) Dyer, J. [23] | - | - | - | - | 1.0 | |||
(9) Van Hemelrijck, M. [24] | - | - | - | - | 1.2 | |||
(10) Eifler, J. B. [25] | - | 770 | - | - | 1.5 | |||
(11) Beyer, J. [26] | - | - | - | 411 | 1.9 | |||
(12) Grasso, M. [27] | - | - | - | 500 | 0.2 | |||
(13) Cindolo, L. [28] | - | - | - | 184 | 0 | |||
(14) Nakamura, K. [29] | - | - | - | 47 | 4 | |||
(15)Koya, M. [30] | - | 1373 | - | - | 0.21 | |||
(16) Cisek, L. [31] | 784 | 516 | - | - | 2.3 |
Study | VTE Incidence Procedure Specific | DVT Incidence (in %) | PE Incidence (in %) | PLND (VTE) | Post-Op Bleeding Episodes (in %) | |||
---|---|---|---|---|---|---|---|---|
O | MIS | O | MIS | O | MIS | |||
(1) Patel, H. D. [17] | 2.4 | 1.1 | - | - | 1.7 | 1.1 | ||
(2) Valverde-Martinez, S. [18] | 2.5 | - | 1.4 | - | - | |||
(3) Weinberg, A. [14] | 0.3 | 0.2 | - | 0.1 | 0.1 | - | - | |
(4) Tollefson, M. K. [19] | 1.5 | 1.0 | - | 1.8 | 1.47 | - | ||
(5) Chan, S.Y [20] | - | 0.9 | - | 0.0 | - | - | ||
(6) Chalmers, D. J. [21] | - | 0.9 | - | - | 1.2 | - | ||
(7) Abel, E. [22] | - | 1.8 | - | - | 0.5 | - | - | |
(8) Dyer, J. [23] | 1.0 | - | - | - | - | |||
(9) Van Hemelrijck, M. [24] | 1.5 | 0.8 | 0.9 | 0.6 | 0.6 | 0.2 | - | - |
(10)Eifler, J. B. [25] | - | - | 0 | 1.5 | - | - | ||
(11) Beyer, J. [26] | 1.9 | - | 0.9 | 0.9 | - | - | ||
(12) Grasso, M. [27] | 0.2 | - | 0 | 0.2 | - | - | ||
(13) Cindolo, L. [28] | 0 | - | 0 | 0 | - | - | ||
(14) Nakamura, K. [29] | 4 | - | 0 | 4 | - | 2.1 | ||
(15)Koya, M. [30] | 0.21 | - | 0.21 | 0 | - | - | ||
(16) Cisek, L. [31] | 2.3 | - | 0.45 | 1.3 | - | - |
Outcome | Method | Number | Heterogeneity | Outcome Occurrence | |
---|---|---|---|---|---|
Studies | p-Value | I2 | % (95% CI) | ||
VTE | All combined | 16 | <0.001 | 97% | 1.0 (0.5, 1.5) |
Comparison | Number | Heterogeneity | Group Difference | ||
---|---|---|---|---|---|
Studies | p-Value | I2 | RR (95% CI) (*) | p-Value | |
MIS/Open | 5 | 0.55 | 0% | 0.63 (0.52, 0.77) | <0.001 |
PLND/no PLND | 2 | 0.96 | 0% | 2.79 (0.86, 8.94) | 0.09 |
Prophylaxis | Number | Heterogeneity | VTE Occurrence | Method Diff. | |
---|---|---|---|---|---|
Method | Studies | p-Value | I2 | % (95% CI) | p-Value |
Mechanical | 5 | 0.002 | 76% | 0.7 (0.1, 1.6) | 0.42 |
Combined | 6 | 0.07 | 51% | 1.0 (0.5, 1.6) |
Open Radical Prostatectomy (+/− PLND) | |||
Pharmacological# | Low Risk | Suggests | weak, moderate-quality evidence |
Medium/High Risk | Recommends | strong, moderate- or high-quality evidence | |
Mechanical* | All patients | Suggested | weak, low-quality evidence |
Open radical prostatectomy with extended PLND | |||
Pharmacological# | All patients | Recommends | strong, moderate, or high-quality evidence |
Mechanical* | All patients | Suggests | weak, low-quality evidence |
Laparoscopic Radical prostatectomy (Without PLND) | |||
Pharmacological# | Low Risk | Recommends (Against) | strong, moderate-quality evidence |
Medium and high risk | Suggests (Against) | weak, moderate- or high-quality evidence | |
Mechanical* | Low risk | Suggests (Against) | weak, low-quality evidence |
Medium and high risk | Suggests | weak, low-quality evidence | |
Laparoscopic Radical prostatectomy (With Standard PLND) | |||
Pharmacological# | Low Risk | Recommends (Against) | strong, moderate-quality evidence |
Medium Risk | Suggests (Against) | weak, moderate- or high-quality evidence | |
High Risk | Recommends | strong, high-quality evidence | |
Mechanical* | All patients | Suggests | weak, low-quality evidence |
Laparoscopic Radical prostatectomy (With Extended PLND) | |||
Pharmacological# | Low Risk | Suggests (Against) | weak, moderate-quality evidence |
Medium Risk | Suggests | weak, high-quality evidence | |
High Risk | Recommends | strong, high-quality evidence | |
Mechanical* | All patients | Suggested | weak, low-quality evidence |
Robotic Radical prostatectomy (Without PLND) | |||
Pharmacological# | Low Risk | Recommends (Against) | strong, moderate-quality evidence |
Medium and High Risk | Suggests (Against) | weak, moderate-quality evidence | |
Mechanical* | Low Risk | Suggests (Against) | weak, low-quality evidence |
Medium and High Risk | Suggests | weak, low-quality evidence | |
Robotic Radical prostatectomy (With Standard PLND) | |||
Pharmacological# | Low Risk | Recommends (Against) | strong, moderate-quality evidence |
Medium Risk | Suggests | weak, moderate-quality evidence | |
High Risk | Suggests | weak, moderate-quality evidence | |
Mechanical* | All patients | Suggests | weak, low-quality evidence |
Robotic Radical prostatectomy (With Extended PLND) | |||
Pharmacological# | Low Risk | Suggests (Against) | weak, moderate-quality evidence |
Medium Risk | Suggests | weak, moderate-quality evidence | |
High Risk | Recommends | strong, moderate-quality evidence | |
Mechanical* | All patients | Suggests | weak, low-quality evidence |
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Wani, M.; Al-Mitwalli, A.; Mukherjee, S.; Nabi, G.; Somani, B.K.; Abbaraju, J.; Madaan, S. Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis. J. Clin. Med. 2023, 12, 3979. https://doi.org/10.3390/jcm12123979
Wani M, Al-Mitwalli A, Mukherjee S, Nabi G, Somani BK, Abbaraju J, Madaan S. Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2023; 12(12):3979. https://doi.org/10.3390/jcm12123979
Chicago/Turabian StyleWani, Mudassir, Abdullah Al-Mitwalli, Subhabrata Mukherjee, Ghulam Nabi, Bhaskar K. Somani, Jayasimha Abbaraju, and Sanjeev Madaan. 2023. "Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis" Journal of Clinical Medicine 12, no. 12: 3979. https://doi.org/10.3390/jcm12123979
APA StyleWani, M., Al-Mitwalli, A., Mukherjee, S., Nabi, G., Somani, B. K., Abbaraju, J., & Madaan, S. (2023). Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 12(12), 3979. https://doi.org/10.3390/jcm12123979