Negative Surgical Outcomes Question

[James]

I was reading an article in the paper today - and it was about a man that died of surgical complications from prostate removal. Now - I understand that this is rare - but does anyone have any stats on the mortality rate of this - I was actually a little surprised at the article - I didn't think that happened much anymore.

So - maybe I am overly ignorant on the topic.

What are the mortality risks (numericly if possible) of LRP or other prostate removal methods.

[G8 GT]

Hi James,

I believe I know which man you are referring too, but it sounds as if there may have been other medical issues involved. IMO, the "negative" surgical outcome will depend on many variables, including but not limited to things such as pre-surgical cardiovascular health, possible obesity issues, etc. I personally have a benign arrythmia, but I would still be worried about being put under anesthesia (even though I have been cleared) and realize there is still a risk involved.

I apologize if we are not supposed to discuss this here, and if so, please remove my post.

Thanks,

Mike

[Arnon Krongrad, MD]

You are referring to a media release about a celebrity who died; it was based upon a report by a "family spokesman" and other than his age and prostate cancer diagnosis it provided essentially no clinical detail.

The release was circulated in two inconsistent versions: One version said he lost his battle with prostate cancer (suggesting metastatic prostate cancer) and one said he died of surgical complications from prostate cancer (which is not the same as "prostate removal" in that there are many surgeries patients with prostate cancer can have). In neither version was it clear about which stage of prostate cancer he had (localized; metastatic), if he had surgery and if so which kind (transurethral prostatectomy; percutaneous nephrostomies; ventriculo-peritoneal shunting; spinal decompression), what he died of (complications of surgery or chemo; end-stage prostate cancer; renal failure; co-existing illness), and which other illnesses he had (obesity; hypertension; diabetes). The report said the patient died at a hospital I work in but it is not clear that he had surgery at this hospital or when he had surgery, if he had surgery. I was in that hospital's operating room the morning that release circulated: Nobody who I asked in that operating room had any idea who this guy was.

So ... Reportedly a man who may have had many diagnoses may have had an unspecified surgery at an unspecified location at an unspecified time and may have wound up in an unspecified unit of the hospital and died of an unspecified cause. My guess is he may have died of metastatic prostate cancer, given the wording in one version, just like Dan Fogelberg "lost his battle with prostate cancer." In any event, the publicly available material provides way too little detail to permit any insights related to prostate surgery or prostatitis.

On to the meat and potatos of our effort here ...

James: For properly selected patients the risk of mortality with radical prostatectomy hovers around zero. In 25 years of open and laparoscopic radical prostatectomy I have not seen a single peri-operative death.

MikeS: Obesity in itself is not a barrier to radical prostatectomy. Having done LRP for men weighing as much as 350 pounds who were off having dinner in a restaurant 2 days later, I can tell you that obesity is not in itself a barrier to surgery. Neither is arrythmia, previous surgery, previous radiation, and a long list of other stuff that happens to patients.

The keys to risk management are the preoperative assessment and planning and the skill of the surgeon.

[G8 GT]

Thank you for the reply Dr. Krongrad. With my arrythmia concern, I realize that I would be cleared, and in good hands, but I would still have a level of anxiety myself because I live with it. For example, I have yet to be put under general anesthesia since I was diagnosed with the arrythmia, so I would need to have it happen now to help diminish my fear.

My other opinion/point is there is never any 100% certainty with avoiding negativity in many surgical environments, but as you said, given the correct preoperative assessment and planning and the skill of the surgeon, this can be essentially eliminated.

I also have read about 4 different articles regarding this mentioned patient who passed. I noticed the inconsistencies in the articles and wondered what the "actual" story was.

[Arnon Krongrad, MD]

"Arrhythmia" is a nonspecific term. Risk varies among the many kinds of arrhythmia. So the information you have provided here does not even provide a crude assessment of actual risk, let alone a refined one. Furthermore, many arrhythmias can be managed with medication, so without knwing which kind you have we cannot speak to management either.

Anxiety is a separate issue as it relates to emotional response to reality and/or perceptions of it. Anxiety also can be addressed. Guess what? Most patients have anxiety when they are diagnosed and when they are about to have surgery. The level tends to vary in relation to their coping styles more than in relation to actual risk. So ... Separate issue.

[G8 GT]

I currently have benign pre-ventricular contractions and pre-atrial contractions, along with rare non-sustained ventricular tachycardia. I am sure my EP would clear me for surgery, I am, and will be nervous for any general anesthesia that I may require in the future. As you mentioned, though, that anxiety can be handled. I do look at the bright side of this particular issue because once it happens, successfully, I will have the experience to overcome that fear.

As a side note; I do notice a strong correlation between my misbeats and gas/pressure. For example, anytime my GERD flares up, I am sure to have more frequent, and sometimes consistent (3-4 minute for 2-3 days) PVC's. My EP did mention a possible correlation between the gas/bloating/heartburn irritating my vagal nerve which in-turn, irritates a specific foci on my heart, causing it to fire out of sync with the sinoatrial node.

[James]

Thanks for the info Doc.

I assumed there was more to that story as the media component was brief.
But it begged the question of mortality risks that I thought should be asked.

I appreciate your response - and that is what I had assumed previously.

[Arnon Krongrad, MD]

So I finally got some more detail ... This was a patient with metastatic prostate cancer. He was brought to the hospital in the end stages of his life and had some sort of abdominal procedure not directly related to his prostate. He died not too long after that. This is consistent with the "lost his battle with prostate cancer" variant of the media release.

[James]

Thank you for the update - I was very curious.

[Arnon Krongrad, MD]

In the information age, patients are choking on data. The data can represent a temptation that is uselessly distracting. This media release is a perfect illustration of the uselessly distracting temptation. Other temptations are less obvious.