Adult urology: CME articlePreoperative cardiopulmonary risk assessment as predictor of early noncancer and overall mortality after radical prostatectomy
Section snippets
Material and methods
All 444 patients (mean age 63.9 years, range 45 to 76) who underwent radical prostatectomy for clinically localized prostate cancer between December 1, 1992 and December 31, 1998, were included in this study. The patients were subdivided into three age groups (less than 60 years; 60 to 69 years; and 70 years or older at surgery). Comorbidity data with relevance for anesthesia (ASA classification [available at http://www.asahq.org/Profinfo/PhysicalStatus.html] and NYHA and CCS classifications
Results
The average follow-up was 4.7 years (surviving patients, range 2.1 to 8.6). In the univariate analysis, the risk of comorbid death was significantly greater among patients with severe systemic disease (ASA 3, Fig. 1), cardiac insufficiency (NYHA 1 or greater, Fig. 2), angina pectoris (CCS 1 or more, Fig. 3), or COPD (P <0.01) compared with those without these conditions. Of the 15 patients who died of comorbidity, 12 (80%) had at least one of the adverse factors (ASA 3, NYHA 1 or more, CCS 1
Comment
The results of this study confirm the prognostic value of the ASA classification in a radical prostatectomy cohort for the early postoperative period analogously to the experiences with head and neck cancer.5, 7 Moreover, the results demonstrate that the NYHA and CCS classifications of cardiac risk may also be used as predictors of comorbid and overall mortality during the first postoperative years. Although too few events occurred to generalize the prognostic model, nevertheless, the
Conclusions
The results of this study demonstrate the capability of preoperative cardiopulmonary risk assessment to predict comorbid and overall mortality with dose-response relationships during the first years after radical prostatectomy. The results of this study encourage additional investigation of preoperative cardiopulmonary risk assessment as source of prognostic information in surgical oncology.
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Which comorbidity classification best fits elderly candidates for radical prostatectomy?
2013, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :We used a heuristic approach based on relatively simple survival analyses to isolate an optimal classification for practical use. The criteria used to rank the classifications resulted from intensive work with comorbidity assessment in the radical prostatectomy setting [16,20,21]. Therefore, there are certainly subjective judgments involved driven by the properties of the investigated comorbidity classifications.
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