Do pelvic dimensions and prostate location contribute to the risk of experiencing complications after radical prostatectomy?

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Surgical complications are more commonly observed in older patients, men with a greater BMI, higher pretreatment PSA greater ASA score, and those who have a longer operative duration. In rectal cancer surgery and prostate cancer surgery, reports suggest that patients with a smaller pelvic size had a higher likelihood of having a positive surgical margin, assumedly due to a more challenging operation in an anatomically narrower pelvis. Whether complication rates are impacted by pelvic size and prostate location has not been investigated yet. To the best of our knowledge our study investigates the largest cohort to date where pelvic bony and soft tissue dimensions were measured on preoperative prostate MRI and correlated with medical and surgical complications to assess if these anatomical factors might impact or predict the development of medical or surgical complications. Anatomical factors that might contribute to the likelihood of developing complications after radical prostatectomy should be identified to adjust and optimize prostate cancer surgery. Preoperative MRI of the prostate and pelvis provides an optimal tool to measure pelvic size and prostate dimensions, as well as prostate location which might be associated with the development of complications after radical prostatectomy. Whether unfavorable anatomy such as a narrow and steep pelvis or a deeply‐situated prostate might lead to a technically more demanding operation, being associated with a higher probability of postoperative complications, remains unclear. Our data suggests that anatomical variation of the pelvis and prostate location do not significantly impact surgical technique in regard to the risk of developing complications after radical prostatectomy in the hand of experienced surgeons. OBJECTIVE • To assess if pelvic size, such as a narrow, steep pelvis, as well as prostate location in relation to the pelvic anatomy might have an impact on the likelihood of experiencing complications after radical prostatectomy. PATIENTS AND METHODS • In a standardized manner, different bony and soft tissue dimensions on preoperative staging MRI were retrospectively measured in a study cohort of 934 patients undergoing radical prostatectomy. Measurements were defined aimed at assessing pelvic size and prostate location. • Medical and surgical complications after radical prostatectomy were meticulously reviewed and grouped into subcategories to assess whether a narrow, steep pelvis and an anatomically deeply situated prostate (which is thought to be more surgically challenging) might be associated with a higher likelihood of postoperative complications. • Multivariate Cox regression was performed to assess if dimensions have a significant impact on the likelihood of postoperative complications. RESULTS • While known parameters such as a higher preoperative PSA and presence of comorbidities were associated with an increased risk of experiencing complications after surgical treatment, none of the dimensions assessed on preoperative MRI had a significant impact on the development of any medical or surgical complication. CONCLUSION • We report the largest cohort of patients where pelvic dimensions were evaluated in a standardized manner on preoperative MRI aimed at assessing anatomic factors and their impact on complications after radical prostatectomy. None of the measurements could significantly predict the likelihood of developing medical or surgical complications.