{"paper_id":"4a42f4b1-5530-4998-9d0a-b65df5ea7611","body_text":"Adverse Events During Radical Prostatectomy and Their Association With Reccurence and Death | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adverse Events During Radical Prostatectomy and Their Association With Reccurence and Death Sofia Erestam, Ying Li, Eva Angenete, Anders Bjartell, Jonas Hugosson, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6716233/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Sep, 2025 Read the published version in World Journal of Urology → Version 1 posted 7 You are reading this latest preprint version Abstract Objective The objective was to explore if adverse events during radical prostatectomy for prostate cancer were associated with the oncological outcomes recurrence, all-cause and prostate cancer specific mortality. One further was to identify risk factors for adverse events. Methods A post-hoc study nested in a prospective, controlled trial of radical prostatectomy by robot assisted laparoscopic or open retropubic approach in Sweden. Adverse events during surgery were collected by clinical record forms (CRFs) filled out by the surgeon at operation. Recurrence was identified by CRFs and patient reports, cause of death through the Swedish National Cause of Death register. Recurrence was defined as undetectable PSA 6-12 weeks after prostatectomy followed by PSA >0.25 ng/ml or treatment for prostate cancer recurrence. Cox regression was used to explore associations between exposure and outcome. Results One/more adverse events occurred during 39% (1356/ 3444) of operations. Adverse events were associated with recurrence, but not with all-cause or prostate cancer specific mortality. Intraoperative extensive bleeding and difficulties during dissection were associated with recurrence. Risk factors included age at surgery, history of TUR-P or abdominal surgery, teaching, prostate weight and lymph node dissection. Limitations included the low number of observations (deaths), particularly in subgroup analyses and hospital volume. This study should be regarded as explorative. Conclusions Adverse events during radical prostatectomy were associated with increased risk for recurrence. Intraoperative bleeding and difficulties during dissection were individual risk factors for recurrence. Risk factors for adverse events were age, prostate weight, prior abdominal surgery and lymph node dissection. Adverse events Prostate cancer Surgical technique Radical prostatectomy Risk factors Oncological outcomes Figures Figure 1 TAKE HOME MESSAGE Adverse events during radical prostatectomy were associated with increased recurrence and all-cause mortality at follow up at 8 or more years after surgery. Possibly increased actions to counteract perioperative bleeding and/or dissection difficulties could be of value. INTRODUCTION Prostate cancer is the most common type of cancer in Sweden ( 1 ). Treatment aimed for cure could be by radiotherapy or surgery, where radical prostatectomy as treatment of localized prostate cancer was found to decrease prostate cancer specific mortality compared with watchful waiting in an early trial but more recently a comparison of prostate cancer specific mortality between active surveillance, surgery or radiotherapy found no significant diffences ( 2 – 4 ). Although initially radical prostatectomy described an open approach, in the last 20 years the minimally invasive approach has replaced it. LAPPRO trial is a prospective, controlled, multicenter, non-randomized trial with the aim to compare two surgical techniques open radical prostatectomy (ORP) and robot assisted laparoscopic prostatectomy (RALP) ( 5 ). Previous studies in the LAPPRO trial have shown that there was no difference between the two surgical techniques regarding primary outcome urinary incontinence at 12 or 24 months, but that RALP resulted in a small benefit in erectile function ( 6 – 8 ). After 8 years follow-up time prostate cancer-specific mortality was lower among patients operated by RALP technique compared with open surgery ( 7 ). Recurrence of cancer is a burden for the patient, psychologically and due to treatment side effects. Known risk factors for recurrence after radical prostatectomy are higher age, tumor grade by Gleason classification, advanced tumor stage, and positive surgical margin, whereas nerve sparing technique was not associated with recurrence ( 9 – 11 ). There are few reports regarding intraoperative adverse events during radical prostatectomy in relation to oncological outcomes. A meta-analysis comparing different surgical techniques for radical prostatectomy concluded that adverse events were less common in the RALP group ( 12 ). The aim of this study was to investigate the association between adverse events during surgery and oncological outcomes in terms of disease recurrence, prostate cancer specific and all-cause mortality within eight years, for the entire cohort in LAPPRO and for RALP and ORP separately. An additional aim was to identify preoperative risk factors for adverse events. METHODS This study is a post-hoc analysis nested within the LAPRO trial. LAPPRO was a prospective, controlled, multicenter trial with the primary end-point to compared two surgical techniques: open radical prostatectomy and robot assisted laparoscopic prostatectomy in regard to urinary incontinence after 12 months. After informed consent patients (n=4003) who were planned to undergo prostatectomy due to localized prostate cancer were included at 14 centers in Sweden between 1 st of September 2008 and 7 th of November 2011. Inclusion criteria at baseline were as follows: age<75 y, prostate specific antigen <20 ng/ml, clinical tumor stage <T4, no diagnosis of metastatic disease, and informed consent to participate in LAPPRO. Seven centers used ORP and seven centers RALP as surgical technique. All patients were asked about inclusion, and exclusion criteria were addressed at analyses. The trial was non-randomized. Data collection After inclusion patients were followed up for eight years, using seven clinical record forms answered by health care personal and six questionnaires distributed to patients as described in detail earlier (4). The intraoperative clinical record form was filled out by the operating surgeon immediately after surgery and included detailed questions on every step of the procedure, including specific questions about perceived difficulties and other adverse events. Cause of death and date of death were retrieved from the National Cause of Death Register (Swedish Board of Health and Welfare). Objectives The primary objective for this exploratory study was to compare a group of patients where adverse events occurred during surgery with a group of patients where no adverse events were recorded during the operation regarding the association with recurrence at 12 months post-operatively or later until eight year follow-up. This analysis was made for the entire cohort and for RALP and ORP separately. The secondary objective was to investigate if adverse events during surgery were associated with all-cause mortality or prostate cancer specific mortality within eight years from surgery, for the entire cohort. Further objectives were to identify preoperative risk factors for adverse events, for the entire cohort and for the two subgroups, separately. Outcomes The primary endpoint recurrence was defined as an initially undetectable PSA value (<0.25 ng/ml) at 6-12 weeks after surgery followed by measurable PSA level at any time during follow-up or by treatment due to recurrence at any time during follow-up (Supplement Table 1) (7). Secondary outcomes were all-cause mortality and prostate cancer specific mortality. Adverse events Intraoperative adverse events have previously been defined as “any significant deviation from the standard surgical procedure, which was unforeseen and/or unintentional, and which significantly complicated the surgery, prolonged the duration of the surgery and/or negatively affected the way the surgery was executed” (13). Adverse events were collected from the intraoperative CRF (Supplementary material), which was filled out by the surgeon immediately after surgery, where objective measures such as operating time or perioperative bleeding as well as subjective variables such as surgeon experiences (“difficulties during dissection”) The CRF was validated by experts and also face validated before being used in LAPPRO. Experiences during the pilot study were also used for revision. Adverse events were grouped into the following seven categories: Prolonged operating time was defined as the longest 10% of the operating duration in ORP and RALP groups respectively. A patient was identified as having an adverse event associated with extended operating time if the operation time exceeded 171.2 minutes in ORP or 264 minutes in RALP. Extensive perioperative bleeding was defined as the highest 10% of bleeding volume in ORP and RALP groups respectively. A patient was identified as having an adverse event related to extensive bleeding if the blood loss exceeded 1300 ml in ORP or 400 ml in RALP. Cutting anastomotic suture/s (yes/no) Difficulties when dissecting (yes/no) Any defined problem during the procedure (yes/no) Adhesiolysis in the abdomen (yes/no) Others, any of the following: conversion to open procedure, repair of damage to other organ, additional surgical procedure (yes/no) The exposure to adverse events was measured in two ways: A) A combined measure: any of adverse events as listed above, dichotomous (Yes / No). B) Each of the adverse events separately as an independent exposure. Statistical methods The associations between the adverse events during surgery and the outcomes, including recurrence, all-cause mortality and prostate cancer specific mortality were investigated with Cox regressions. Follow-up for the time-to-event analyses (for mortality and recurrence) began at the time of surgery. For mortality, patients were followed until at their date of death according to the Swedish Cause of Death Register. Patients who did not die were censored at the data retrieval date. Recurrence was considered as time to event outcome, with follow-up at 12 and 24 months, and 6, 8 years. The exact date of the events (PSA increase or initiation of adjuvant/salvage treatment) or censoring (dropout, mortality or no event at 8 years) are interval-censored between the current and previous follow-up dates. For this reason, the event time was set to the midpoint between the two consecutive follow-up dates. For example, if an elevated PSA was reported at 24 months but not at 12 months, it was assumed to have occurred at 18 months. The analysis was adjusted for the clinical T stage (T1-T3), preoperative PSA, Gleason score on biopsy, length of cancer in preoperative biopsy cores, and prostate weight. The proportion hazard assumption was assess using the score test (cox.zph() function in R). Since there was an indication of a violation of the proportional hazards for preoperative PSA, this variable was included in time-dependent format using the tt() function in coxph package in R. This investigation was conducted across the entire study cohort and within the two sub-groups robot assisted laparoscopic and open surgery respectively. Backward variable selection utilizing Akaike information criterion (AIC) was employed to identify the predictive variables for the combined adverse event during surgery. The combined adverse event, as defined earlier, encompassed any adverse event from the seven groups. The variables were: age at surgery (age<60, 60-<70, >=70), BMI (>30/<=30), TUR-P in history (Yes/No), abdominal surgery in history (Yes/No), clinical T-stage (T1-T3), preoperative Gleason score, surgeon experience (number of surgeries had performed), surgeon participation in teaching during surgery prostate weight (0- <20; 20- <40; 40- <60; 60- <80; >=80) and lymph node dissection (Yes/No). Bootstrap was used to perform stability investigations. The basic idea of bootstrap stability investigation is to draw N resamples from the original data set and to repeat variables selection in each of the resamples. In this study, we drew 100 sets of resamples. Variable of importance (VIF) was presented which indicated how often a certain variable was selected in the model in the 100 simulations. All the analyses were conducted in R version 4.3.2. Ethics The Regional Ethics Review Board in Gothenburg, Sweden, approved the study 2007 (No 277-07) with additional permissions 2014-07-28 plus 2015-04-24 for continued follow-up and data retrieval. The trial was conducted in accordance with the Declaration of Helsinki. After information about the trial and a possibility to ask questions and receive answers from local investigators all participants gave signed consent. The trial was registered at ISRCTN 07/02/2008 (ISRCTN06393679). RESULTS LAPPRO included 4003 patients who underwent radical prostatectomy for localized prostate cancer out of which 834 were eligible for analyses after ORP and 2610 after RALP (Fig 1). We found that in 1356 out of 3444 (39.4%) procedures, surgeons reported one or more adverse events. Patients with intraoperative adverse events were somewhat younger than patients with no such adverse events but had similar BMI (Supplementary Table 2a). Operating time was longer in RALP whereas perioperative bleeding was higher in the ORP group (Supplementary Table 2b). Any adverse event during surgery (combined level) was associated with increased risk for recurrence within eight years of surgery in the entire group of patients (HR 1.45; CI 1.12 – 1.77; p <0.001) (Table 1a), as well as after RALP (Table 1b) but not after ORP (Table 1c). When analyzing the seven types of adverse events separately in the entire cohort, there were associations between three of them and recurrence: perioperative extensive bleeding (HR 1.66; CI 1.28 – 2.14; p <0.001), difficulties when dissecting (HR 1.34; CI 1.08 – 1.63; p =0.01), and an overall statement “any defined problem during surgery” (HR 1.20; CI 1.0 – 1.44; p=0.045) (Table 1a). In the ORP subgroup extensive perioperative bleeding was associated with recurrence and in the RALP subgroup this was also the case, as was “difficult dissection” (Table 1b, 1c). In a supporting analysis total blood loss volume was associated with recurrence in those operated by open technique (HR 1.0006 (1.0005,1.001), p<0.0001) and in the RALP group (HR 1.001 (1.0004,1.001), p<0.0001). Table 1. Patient characteristics for groups with adverse events and without respectively, as well as the group of patients with one or more variables missing, regardless of type of surgery and patients operated by open retropubic prostatectomy (ORP) and robot assisted laparoscopic prostatectomy (RALP) respectively, during radical prostatectomy. Characteristic No adverse event n = 935 Adverse Event n = 1356 Missing n = 1153 ORP, n = 834 RALP, n = 2610 Age at surgery, years 1 62 (57, 66) 64 (59, 67) 63 (59, 67) 63 (59, 67) 63 (58, 67) Preoperative BMI, kg/m 2 , 1 25 (24, 28) 26 (25, 29) 26 (24, 28) 26 (25, 28) 26 (24, 29) Missing (n) 89 175 170 86 348 Clinical_T_stage, number (%) 0 602 (64%) 811 (60%) 688 (60%) 555 (67%) 1,546 (59%) 1 313 (33%) 503 (37%) 423 (37%) 250 (30%) 989 (38%) 2 20 (2.1%) 42 (3.1%) 42 (3.6%) 29 (3.5%) 75 (2.9%) Preoperative Gleason score >=8, number (%) 33 (3.5%) 90 (6.7%) 70 (6.1%) 47 (5.6%) 146 (5.6%) Missing (n) 5 3 6 1 13 Preoperative PSA, ng/ml 1 5.7 (4.2, 8.1) 6.4 (4.6, 9.3) 6.0 (4.5, 8.6) 6.3 (4.5, 9.1) 6.0 (4.4, 8.7) Length of cancer in biopsy, mm 1 7 (4, 14) 8 (4, 16) 8 (4, 17) 7 (3, 15) 8 (4, 16) Missing (n) 44 94 92 84 146 Prostate weight, g 1 40 (33, 50) 44 (36, 56) 43 (35, 52) 44 (36, 54) 42 (34, 53) Missing (n) 5 15 26 14 32 Operation time, min 1 165 (141, 193) 196 (154, 247) 115 (78, 158) 94 (75, 135) 181 (151, 219) Missing (n) 0 180 320 39 461 Lymph node dissection performed, number (%) 22 (2.4%) 116 (8.6%) 67 (5.8%) 92 (11%) 113 (4.3%) Intraoperative bleeding, ml 1 100 (50, 200) 200 (100, 500) 250 (100, 550) 550 (350, 800) 100 (50, 200) Missing (n) 0 49 153 17 185 Surgeon experience, number 1 181 (103, 290) 152 (71, 310) 241 (110, 818) 511 (126, 1,153) 162 (81, 283) Missing (n) 7 9 12 15 13 BCR, n (%) 173 (19%) 360 (27%) 252 (22%) 195 (23%) 590 (23%) Missing (n) 6 8 6 4 16 All-cause mortality, n (%) 41 (4.4%) 96 (7.1%) 78 (6.8%) 66 (7.9%) 149 (5.7%) Prostate cancer specific mortality, n (%) 10 (1.1%) 23 (1.7%) 28 (2.4%) 22 (2.6%) 39 (1.5%) There was an association between adverse events during radical prostatectomy and all-cause mortality (HR 1.46; CI 1.0 – 2.12; p <0.05) looking at the entire cohort and the combination of all seven types of adverse events (Table 2). Adverse events were not associated with prostate cancer specific mortality (Supplement Table 3). Table 2. Association between adverse events during surgery and recurrence within 8 years of surgery Any type of surgery Hazard ratio 95% CI 1 p-value Combined adverse events group 1-7 1.45 1.19 1.77 <0.001 Combined adverse events group 2-7 1.47 1.22 1.77 <0.001 1 Operating time 1.14 0.88 1.47 0.31 2 Perioperative bleeding 1.66 1.28 2.14 <0.001 3 Cutting anastomotic suture/s 1.04 0.80 1.36 0.77 4 Difficult dissection 1.34 1.08 1.68 0.01 5 Any defined problem 1.20 1.00 1.44 0.04 6 Adhesiolysis 0.98 0.54 1.77 0.94 7 Other 0.72 0.27 1.93 0.51 Open radical prostatectomy (ORP) Hazard ratio 95% CI 1 p- value Combined adverse events group 1-7 2 - - - - Combined adverse events group 2-7 3.68 0.89 15.25 0.07 1 Operating time 1.13 0.70 1.83 0.61 2 Perioperative bleeding 2.19 1.43 3.37 <0.001 3 Cutting anastomotic suture/s 1.25 0.69 2.26 0.47 4 Difficult dissection 1.40 0.37 5.25 0.62 5 Any defined problem 1.45 0.96 2.20 0.08 6 Adhesiolysis 7 Other 1.08 0.27 4.36 0.92 Robot assisted laparoscopic radical prostatectomy (RALP) Hazard ratio 95% CI 1 p- value Combined adverse events group 1-7 1.42 1.15 1.74 0.001 Combined adverse events group 2-7 1.40 1.15 1.71 0.001 1 Operating time 1.15 0.85 1.55 0.36 2 Perioperative bleeding 1.44 1.04 2.00 0.03 3 Cutting anastomotic suture/s 1.00 0.74 1.36 0.99 4 Difficult dissection 1.37 1.08 1.73 0.01 5 Any defined problem 1.16 0.95 1.42 0.14 6 Adhesiolysis 1.04 0.57 1.90 0.89 7 Other 0.52 0.13 2.10 0.36 Adjusted for clinical T stage, preoperative PSA, Gleason score on biopsy and prostate weight 1 Indicates confidence interval 2 Not analyzed due to missing values Table 3. Association between adverse events during radical prostatectomy and all-cause mortality. Hazard ratio 95% CI 1 p- value Combined adverse events group 1-7 1.46 1.00 2.12 0.049 Combined adverse events group 2-7 1.42 1.00 2.01 0.05 1 Operating time 1.31 0.87 1.97 0.20 2 Perioperative bleeding 1.79 1.17 2.74 0.01 3 Cutting anastomotic suture/s 0.81 0.48 1.37 0.43 4 Difficult dissection 1.01 0.66 1.55 0.94 5 Any defined problem 1.27 0.93 1.73 0.13 6 Adhesiolysis 0.88 0.28 2.74 0.82 7 Other 0.64 0.09 4.53 0.65 Adjusted for clinical T stage, preoperative PSA, Gleason score on biopsy and prostate weight 1 Indicates confidence interval We identified pre- or perioperative risk factors for adverse events during surgery (Table 4), where age at surgery (OR 1.34; CI 1.00 – 1.55), BMI (OR 1.95; CI 1.43 - 2.71), prostate weight (OR 1.38; CI 1.22 – 1.54), TUR-P (OR 3.7; CI 1.82 – 9.53), prior abdominal surgery (OR 1.31; CI 1.00 – 1.75), teaching during surgery (OR 1.3; CI 1.00 – 1.58), and lymph node dissection (OR 4.72; CI 2.75 – 8.61) were variables of importance (VIF). When removing operating time from the equation teaching disappeared as a variable of importance ( Table 4). Table 4. Risk factors for adverse events, combined group 1-7 and combined group 2-7. combined 1-7 combined 2-7 Risk factor VIF 1 OR 2 95% CI 3 VIF 1 OR 2 95% CI 3 Age 96 1.34 1, 1.55 98 1.28 1.13, 1.5 BMI 100 1.95 1.43, 2.71 99 1.98 1.55, 2.72 Previous TUR-P 100 3.7 1.82, 9.53 98 2.99 1.56, 5.89 Previous abdominal surgery 75 1.31 1, 1.75 80 1.32 1, 1.69 cT 6 1 0.84, 1 18 1 0.87, 1.21 Preop_Gleason_score 23 1 1, 1.8 15 1 0.63, 1.43 Prostate_weight 100 1.38 1.22, 1.54 100 1.35 1.24, 1.51 Lymph_node dissection 100 4.72 2.75, 8.61 98 2.3 1.52, 3.83 Surgeon experience 19 1 1, 1 16 1 1, 1 Teaching in OR 92 1.3 1, 1.58 16 1 0.9, 1.21 Adjusted for clinical T stage, preoperative PSA, Gleason score on biopsy and prostate weight 1 VIF: variable of importance. In 100 simulations, the variable was selected this number of times in the model. 2 Indicates Odds Ratio 3 Indicates confidence interval DISCUSSION Adverse events during radical prostatectomy for prostate cancer were associated with an increased risk for recurrence. Specifically, three of the defined adverse events, perioperative bleeding, difficulty at dissection and reporting “any defined problem during surgery” were separately related to increased risk for recurrent disease. An association between intraoperative adverse events and local recurrence within five years after surgery for rectal cancer has been reported ( 13 ) and adverse events after abdominal surgery have reportedly been associated with a higher risk of postoperative mortality, morbidity and increased postoperative length of stay ( 14 ). We identified several preoperative risk factors for adverse events during surgery. Knowledge about such risk factors could be one basis in the preoperative discussion between patient and surgeon to plan the extent of surgery such as with/without lymph node dissection or just to increase surgeon’s awareness about possible adverse events and the. The list of adverse events expressed as questions in the clinical record form (CRF) filled out by the surgeons at the time of the surgery, included objective measures. Several questions had answer alternatives Yes or No, without follow up questions about extent. Other questions represented subjective experiences such as cutting stitch (meaning stitch cutting through urethra or bladder neck during the anastomosis), difficulty during dissection, any problem during the operation, all answered by Yes/No. Regarding a cutting stitch this most often reflects increased tension in the anastomosis. Usually another stitch is placed and there is no need to take down the whole anastomosis. However we do not have the exact information for each patient about consequences of a cutting stich. As the answers to questions about experiences described above were categorical it is not possible to extend analyses to how much or how difficult. There is as always a balance between number of questions, degree of details covered and compliance in filling out the questionnaire. Dissection difficulties were associated with recurrence in the robot operated group and for the entire cohort. Part of the explanation for the somewhat diverse findings could be lack of power, as number of events decreased with subgrouping, especially in the openly operated group. Extensive blood loss during surgery was associated with recurrence also in the subgroups, and this is an indication that this association was not technique specific. Importantly it should be noted that we defined “blood loss” as the top 10% percentile of perioperative bleeding for each technique and as blood loss was significantly smaller in RALP compared with ORP “extensive blood loss volume” was different in the two techniques. We suggest that blood loss, defined as the top 10% percentile represents technical difficulties during the surgical procedure rather than the actual volume of blood lost. “Dissecting difficulties” and “Any defined problem during surgery” were also associated with worse oncological outcome which would suggest that our interpretation of a mediation between excessive blood loss and oncological outcome could be correct, that the blood loss should be regarded as proxy for difficulties during surgery. Although adverse events and risk factors were associated with higher risk of recurrence, the analyses of mortality suffer from lack of power due to the restricted number of events (deaths) ( 7 , 8 ). We have earlier described an inverse relationship between surgeon satisfaction measured directly after the operation and intraoperative events such as technical difficulties and intraoperative complications as described by the surgeon at the time ( 16 ). The present results add important knowledge regarding the implication of intraoperative events for oncological outcomes. It could be suggested that surgeon satisfaction could be a relevant quality outcome of radical prostatectomy. Whether surgeon dissatisfaction could be used as “proxy” for a need for more frequent follow-up, would need further studies. Our results suggest that all possible pre- and perioperative measures to reduce bleeding should be undertaken, such as checking medications preoperatively and immediately respond to perioperative bleeding with the aim to control. We have earlier reported a difference regarding perioperative blood loss volume between the two techniques, in favor of RALP ( 15 ), similar to most reports about laparoscopic surgery regardless of type of procedure ( 17 , 18 ). This phenomenon has been attributed in part to the necessity to perform “bloodless surgery” as bleeding during any type of laparoscopy results in decreased visibility. Another hypothesis is that the positive pressure inside the abdominal cavity during any laparoscopic procedure, by the insufflation of carbon dioxide at a positive pressure, will overcome the pressure in venules/small veins and thus result in a rapid cessation of small bleeding points. Still our results indicate that it is not only the blood loss (volume) itself as it was the relative increase of blood loss that increased the risk for recurrence. Awareness that age is a risk factor could indicate the need for re-consideration of surgery as primary treatment in certain cases, but more often in efforts to optimize the patient while waiting for surgery as well as optimizing the operation as such. The adverse event “difficulties at dissection” could possibly be counteracted by considering a “two surgeon principle”, a routine to ensure experience but at the same time to increase experience by using one procedure to increase experience for two surgeons ( 19 ). Strengths in this study included the intraoperative clinical record form filled out by the operating surgeon, in immediate connection with the operation. The recording of adverse events is both systematic and detailed, and in combination with immediate reporting could be taken as an indication of high validity of data, compared with retrospective study designs using medical records ( 13 ). Further strengths were the cohort size as well as the multicenter design. The lack of established definitions of the various adverse events should be regarded as a limitation, to some extent balanced by distinct questions and answer alternatives in the clinical record form. The non-randomized design is a limitation. Another limitation relates to a low number of events (deaths), particularly in subgroup analyses. A further limitation could be that surgeon experience was not included in the statistical models, neither was center. This study is explorative in nature, and the outcomes were not the primary endpoint of the LAPPRO trial. Conclusions This explorative study found associations between adverse events during radical prostatectomy and recurrence, and extensive perioperative bleeding, a difficult dissection and other defined problems during the procedure individually were associated with recurrence. Some risk factors for adverse events were identified. An increased awareness that adverse events during surgery relate to oncologic outcome is warranted. Further work would be needed in order to identify factors predictive of surgery without adverse events. Declarations AUTHORS´ CONTRIBUTONS All authors contributed to the statistical analysis plan, the interpretation of results and to editing and revising the manuscript and all have approved of the final manuscript. The authors have no conflicts of interest to disclose. ACKNOWLEDGEMENT The authors gratefully acknowledge important contributions from late professor Gunnar Steineck, MD, PhD, to the LAPPRO trial and the plan of analyses for this study. All surgeons who filled out the perioperative CRF are gratefully acknowledged. The authors would like to thank local investigators, Ingrid Höglund-Karlsson RN and all research staff for their excellent work. FUNDING This study was supported by research grants from the Swedish Cancer Society (2008/922, 2010/593, 2013/497, 2016/362, Pj2019 0303, Pj22 2006), The Swedish Research Council (2012-1770, 2015-02483), Region Västra Götaland, Sahlgrenska University Hospital (ALFBGB grants 13875, 146201, 4307771, 718221, 965245; HTA–VGR 6011; agreement concerning research and education of doctors), the Mrs. Mary von Sydow Foundation, and the Anna and Edvin Berger Foundation. The funding sources had no role in the design, analysis, interpretation or writing of the manuscript. References Socialstyrelsen. Statistik om nyupptäckta cancerfall. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/statistik/2022-12-8308.pdf Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in early prostate cancer. New England J Medicine . Mar 06 2014;370(10):932-42. Bill-Axelson A, Holmberg L, Garmo H, et al. 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The impact of length and location of positive margins in predicting biochemical recurrence after robot-assisted radical prostatectomy with a minimum follow-up of 5 years. BJU international . Jan 2015;115(1):106-13. Tewari A, Sooriakumaran P, Bloch DA, et al. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Euro Urol . Jul 2012;62(1):1-15. Waldenstedt S, Bock D, Haglind E, et al. Intraoperative adverse events as a risk factor for local recurrence of rectal cancer after resection surgery. Colorectal Dis . 2022 Apr;24(4):449-460. Bohnen JD, Mavros MN, Ramly EP, et al. Intraoperative Adverse Events in Abdominal Surgery: What Happens in the Operating Room Does Not Stay in the Operating Room. Ann Surg . Jun 2017;265(6):1119-1125. Wallerstedt A, Tyritzis SI, Thorsteinsdottir T, et al. Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy. Eur Urol. 2015 Apr;67(4):660-70. Erestam S, Bock D, Erichsen Andersson A, et al. Associations between intraoperative factors and surgeons' self-assessed operative satisfaction. Surg Endosc. 2020 Jan;34(1):61-68. Veldkamp R, Kuhry E, Bonjer HJ,et al . Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005;6(7):477-84 van der Pas MH, Haglind E, Cuesta MA,et al . Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013;14(3):210-8 Matsuura N, Igai H, Ohsawa F, Numajiri K, Kamiyoshihara M. Learning curve for uniportal thoracoscopic pulmonary segmentectomy: how many procedures are required to acquire expertise? Transl Lung Cancer Res. 2023 Jul 31;12(7):1466-1476 Additional Declarations No competing interests reported. Supplementary Files SUPPLEMENTORYMATERIAL20240704.docx Cite Share Download PDF Status: Published Journal Publication published 23 Sep, 2025 Read the published version in World Journal of Urology → Version 1 posted Editorial decision: Revision requested 22 Jul, 2025 Reviews received at journal 19 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers invited by journal 11 Jun, 2025 Editor assigned by journal 10 Jun, 2025 Submission checks completed at journal 10 Jun, 2025 First submitted to journal 21 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6716233\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":470158784,\"identity\":\"f979ac38-45d3-428a-8b19-f847567509e5\",\"order_by\":0,\"name\":\"Sofia Erestam\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Gothenburg\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sofia\",\"middleName\":\"\",\"lastName\":\"Erestam\",\"suffix\":\"\"},{\"id\":470158786,\"identity\":\"42e6e414-6794-4f17-aa69-c01eb748c663\",\"order_by\":1,\"name\":\"Ying 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11:53:27\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6716233/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6716233/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1007/s00345-025-05932-7\",\"type\":\"published\",\"date\":\"2025-09-23T15:57:12+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":84703920,\"identity\":\"1cf139df-da79-49ef-8363-b31016ce4820\",\"added_by\":\"auto\",\"created_at\":\"2025-06-16 12:02:14\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":41630,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eStudy flow chart.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6716233/v1/38d3f8d2797bb5dd66547f0f.png\"},{\"id\":92430492,\"identity\":\"b906b9bd-da36-47ac-b463-cea9ca144893\",\"added_by\":\"auto\",\"created_at\":\"2025-09-29 16:05:29\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1485781,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6716233/v1/a1903037-672a-4497-a640-3f6cf6ab9923.pdf\"},{\"id\":84703922,\"identity\":\"c03f9271-e809-402f-aed7-64692db24cbf\",\"added_by\":\"auto\",\"created_at\":\"2025-06-16 12:02:14\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":727227,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SUPPLEMENTORYMATERIAL20240704.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6716233/v1/8fcb4d60fecf2c24027b6366.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eAdverse Events During Radical Prostatectomy and Their Association With Reccurence and Death\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"TAKE HOME MESSAGE\",\"content\":\"\\u003cp\\u003eAdverse events during radical prostatectomy were associated with increased recurrence and all-cause mortality at follow up at 8 or more years after surgery. Possibly increased actions to counteract perioperative bleeding and/or dissection difficulties could be of value.\\u003c/p\\u003e\"},{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eProstate cancer is the most common type of cancer in Sweden (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). Treatment aimed for cure could be by radiotherapy or surgery, where radical prostatectomy as treatment of localized prostate cancer was found to decrease prostate cancer specific mortality compared with watchful waiting in an early trial but more recently a comparison of prostate cancer specific mortality between active surveillance, surgery or radiotherapy found no significant diffences (\\u003cspan additionalcitationids=\\\"CR3\\\" citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Although initially radical prostatectomy described an open approach, in the last 20 years the minimally invasive approach has replaced it.\\u003c/p\\u003e \\u003cp\\u003eLAPPRO trial is a prospective, controlled, multicenter, non-randomized trial with the aim to compare two surgical techniques open radical prostatectomy (ORP) and robot assisted laparoscopic prostatectomy (RALP) (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). Previous studies in the LAPPRO trial have shown that there was no difference between the two surgical techniques regarding primary outcome urinary incontinence at 12 or 24 months, but that RALP resulted in a small benefit in erectile function (\\u003cspan additionalcitationids=\\\"CR7\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e). After 8 years follow-up time prostate cancer-specific mortality was lower among patients operated by RALP technique compared with open surgery (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eRecurrence of cancer is a burden for the patient, psychologically and due to treatment side effects. Known risk factors for recurrence after radical prostatectomy are higher age, tumor grade by Gleason classification, advanced tumor stage, and positive surgical margin, whereas nerve sparing technique was not associated with recurrence (\\u003cspan additionalcitationids=\\\"CR10\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThere are few reports regarding intraoperative adverse events during radical prostatectomy in relation to oncological outcomes. A meta-analysis comparing different surgical techniques for radical prostatectomy concluded that adverse events were less common in the RALP group (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe aim of this study was to investigate the association between adverse events during surgery and oncological outcomes in terms of disease recurrence, prostate cancer specific and all-cause mortality within eight years, for the entire cohort in LAPPRO and for RALP and ORP separately. An additional aim was to identify preoperative risk factors for adverse events.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cp\\u003eThis study is a post-hoc analysis\\u0026nbsp;nested within the LAPRO trial. LAPPRO was a prospective, controlled, multicenter trial with the primary end-point to compared two surgical techniques: open radical prostatectomy and robot assisted laparoscopic prostatectomy in regard to urinary incontinence after 12 months. After informed consent patients (n=4003) who were planned to undergo prostatectomy due to localized prostate cancer were included at 14 centers in Sweden between 1\\u003csup\\u003est\\u003c/sup\\u003e of September 2008 and 7\\u003csup\\u003eth\\u003c/sup\\u003e of November 2011. Inclusion criteria at baseline were as follows: age\\u0026lt;75 y, prostate specific antigen \\u0026lt;20 ng/ml, clinical tumor stage \\u0026lt;T4, no diagnosis of metastatic disease, and informed consent to participate in LAPPRO. Seven centers used ORP and seven centers RALP as surgical technique. All patients were asked about inclusion, and exclusion criteria were addressed at analyses. The trial was non-randomized.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData collection\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAfter inclusion patients were followed up for eight years, using seven clinical record forms answered by health care personal and six questionnaires distributed to patients as described in detail earlier (4). The intraoperative clinical record form was filled out by the operating surgeon immediately after surgery and included detailed questions on every step of the procedure, including specific questions about perceived difficulties and other adverse events. Cause of death and date of death were retrieved from the National Cause of Death Register (Swedish Board of Health and Welfare).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eObjectives\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe primary objective for this exploratory study was to compare a group of patients where adverse events occurred during surgery with a group of patients where no adverse events were recorded during the operation regarding the association with recurrence at 12 months post-operatively or later until eight year follow-up. \\u0026nbsp;This analysis was made for the entire cohort and for RALP and ORP separately.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe secondary objective was to investigate if adverse events during surgery were associated with all-cause mortality or prostate cancer specific mortality within eight years from surgery, for the entire cohort. Further objectives were to identify preoperative risk factors for adverse events, for the entire cohort and for the two subgroups, separately.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOutcomes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe primary endpoint recurrence was defined as an initially undetectable PSA value (\\u0026lt;0.25 ng/ml) at 6-12 weeks after surgery followed by measurable PSA level at any time during follow-up or by treatment due to recurrence at any time during follow-up (Supplement Table 1) (7). Secondary outcomes were all-cause mortality and prostate cancer specific mortality.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAdverse events\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIntraoperative adverse events have previously been defined as \\u0026ldquo;any significant deviation from the standard surgical procedure, which was unforeseen and/or unintentional, and which significantly complicated the surgery, prolonged the duration of the surgery and/or negatively affected the way the surgery was executed\\u0026rdquo; (13).\\u003c/p\\u003e\\n\\u003cp\\u003eAdverse events were collected from the intraoperative CRF (Supplementary material), which was filled out by the surgeon immediately after surgery, where objective measures such as operating time or perioperative bleeding as well as subjective variables such as surgeon experiences (\\u0026ldquo;difficulties during dissection\\u0026rdquo;) The CRF was validated by experts and also face validated before being used in LAPPRO. Experiences during the pilot study were also used for revision.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAdverse events were grouped into the following seven categories:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003col\\u003e\\n \\u003cli\\u003eProlonged operating time was defined as the longest 10% of the operating duration in ORP and RALP groups respectively. A patient was identified as having an adverse event associated with extended operating time if the operation time exceeded 171.2 minutes in ORP or 264 minutes in RALP.\\u003c/li\\u003e\\n \\u003cli\\u003eExtensive perioperative bleeding was defined as the highest 10% of bleeding volume in ORP and RALP groups respectively. A patient was identified as having an adverse event related to extensive bleeding if the blood loss exceeded 1300 ml in ORP or 400 ml in RALP.\\u003c/li\\u003e\\n \\u003cli\\u003eCutting anastomotic suture/s (yes/no)\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eDifficulties when dissecting (yes/no)\\u003c/li\\u003e\\n \\u003cli\\u003eAny defined problem during the procedure (yes/no)\\u003c/li\\u003e\\n \\u003cli\\u003eAdhesiolysis in the abdomen (yes/no)\\u003c/li\\u003e\\n \\u003cli\\u003eOthers, any of the following: conversion to open procedure, repair of damage to other organ, additional surgical procedure (yes/no)\\u003c/li\\u003e\\n\\u003c/ol\\u003e\\n\\u003cp\\u003eThe exposure to adverse events was measured in two ways:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eA) A combined measure: any of adverse events as listed above, dichotomous (Yes / No).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eB) Each of the adverse events separately as an independent exposure.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical methods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe associations between the adverse events during surgery and the outcomes, including recurrence, all-cause mortality and prostate cancer specific mortality were investigated with Cox regressions. \\u0026nbsp;Follow-up for the time-to-event analyses (for mortality and recurrence) began at the time of surgery. For mortality, patients were followed until at their date of death according to the Swedish Cause of Death Register. Patients who did not die were censored at the data retrieval date. Recurrence was considered as time to event outcome, with follow-up at 12 and 24 months, and 6, 8 years. The exact date of the events (PSA increase or initiation of adjuvant/salvage treatment) or censoring (dropout, mortality or no event at 8 years) are interval-censored between the current and previous follow-up dates. For this reason, the event time was set to the midpoint between the two consecutive follow-up dates. For example, if an elevated PSA was reported at 24 months but not at 12 months, it was assumed to have occurred at 18 months. The analysis was adjusted for the clinical T stage (T1-T3), preoperative PSA, Gleason score on biopsy, length of cancer in preoperative biopsy cores, and prostate weight. \\u0026nbsp;The proportion hazard assumption was assess using the score test (cox.zph() function in R). Since there was an indication of a violation of the proportional hazards for preoperative PSA, this variable was included in time-dependent format using the tt() \\u0026nbsp; function in coxph package in R. This investigation was conducted across the entire study cohort and within the two sub-groups robot assisted laparoscopic and open surgery respectively.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eBackward variable selection utilizing Akaike information criterion (AIC) was employed to identify the predictive variables for the combined adverse event during surgery. \\u0026nbsp; The combined adverse event, as defined earlier, encompassed any adverse event from the seven groups. The variables were: age at surgery (age\\u0026lt;60, 60-\\u0026lt;70, \\u0026gt;=70), BMI (\\u0026gt;30/\\u0026lt;=30), TUR-P in history (Yes/No), abdominal surgery in history (Yes/No), clinical T-stage (T1-T3), preoperative Gleason score, surgeon experience (number of surgeries had performed), surgeon participation in teaching during surgery prostate weight (0- \\u0026lt;20; 20- \\u0026lt;40; 40- \\u0026lt;60; 60- \\u0026lt;80; \\u0026gt;=80) and lymph node dissection (Yes/No). Bootstrap was used to perform stability investigations. The basic idea of bootstrap stability investigation is to draw N resamples from the original data set and to repeat variables selection in each of the resamples. \\u0026nbsp;In this study, we drew 100 sets of resamples. Variable of importance (VIF) was presented which indicated how often a certain variable was selected in the model in the 100 simulations.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAll the analyses were conducted in R version 4.3.2.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe Regional Ethics Review Board in Gothenburg, Sweden, approved the study 2007 (No 277-07) with additional permissions 2014-07-28 plus 2015-04-24 for continued follow-up and data retrieval. The trial was conducted in accordance with the Declaration of Helsinki. After information about the trial and a possibility to ask questions and receive answers from local investigators all participants gave signed consent. The trial was registered at ISRCTN 07/02/2008 (ISRCTN06393679).\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eLAPPRO included 4003 patients who underwent radical prostatectomy for localized prostate cancer out of which 834 were eligible for analyses after ORP and 2610 after RALP (Fig 1).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eWe found that in 1356 out of 3444 (39.4%) procedures, surgeons reported one or more adverse events. Patients with intraoperative adverse events were somewhat younger than patients with no such adverse events but had similar BMI (Supplementary Table 2a). Operating time was longer in RALP whereas perioperative bleeding was higher in the ORP group (Supplementary Table 2b).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAny adverse event during surgery (combined level) was associated with increased risk for recurrence within eight years of surgery in the entire group of patients (HR 1.45; CI 1.12 \\u0026ndash; 1.77; p \\u0026lt;0.001) (Table 1a), as well as after RALP (Table 1b) but not after ORP (Table 1c). When analyzing the seven types of adverse events separately in the entire cohort, there were associations between three of them and recurrence: perioperative extensive bleeding (HR 1.66; CI 1.28 \\u0026ndash; 2.14; p \\u0026lt;0.001), difficulties when dissecting (HR 1.34; CI 1.08 \\u0026ndash; 1.63; p =0.01), and an overall statement \\u0026ldquo;any defined problem during surgery\\u0026rdquo; (HR 1.20; CI 1.0 \\u0026ndash; 1.44; p=0.045) (Table 1a). In the ORP subgroup extensive perioperative bleeding was associated with recurrence and in the RALP subgroup this was also the case, as was \\u0026ldquo;difficult dissection\\u0026rdquo; (Table 1b, 1c). In a supporting analysis total blood loss volume was associated with recurrence in those operated by open technique (HR 1.0006 (1.0005,1.001), p\\u0026lt;0.0001) and in the RALP group (HR 1.001 (1.0004,1.001), p\\u0026lt;0.0001).\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eTable 1.\\u003c/em\\u003e Patient characteristics for groups with adverse events and without respectively, as well as the group of patients with one or more variables missing, regardless of type of surgery\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eand patients\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eoperated by open retropubic prostatectomy (ORP) and robot assisted laparoscopic prostatectomy (RALP) respectively, during radical prostatectomy.\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\" width=\\\"603\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristic\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo adverse event\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;n = 935\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAdverse Event\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;n = 1356\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMissing\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003en = 1153\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eORP,\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003en = 834\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRALP,\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003en = 2610\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge at surgery, years\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e62 (57, 66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e64 (59, 67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e63 (59, 67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e63 (59, 67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e63 (58, 67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePreoperative BMI, kg/m\\u003csup\\u003e2\\u003c/sup\\u003e,\\u003csup\\u003e\\u0026nbsp;1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e25 (24, 28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e26 (25, 29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e26 (24, 28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e26 (25, 28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e26 (24, 29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Missing (n)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e175\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e170\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e86\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e348\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eClinical_T_stage, number (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\u0026nbsp;\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; 0\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e602 (64%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e811 (60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e688 (60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e555 (67%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e1,546 (59%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; 1\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e313 (33%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e503 (37%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e423 (37%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e250 (30%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e989 (38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; 2\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e20 (2.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e42 (3.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e42 (3.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e29 (3.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e75 (2.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePreoperative Gleason score \\u0026gt;=8, number (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e33 (3.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e90 (6.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e70 (6.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e47 (5.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e146 (5.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Missing (n)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePreoperative PSA, ng/ml\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e5.7 (4.2, 8.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e6.4 (4.6, 9.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e6.0 (4.5, 8.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e6.3 (4.5, 9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e6.0 (4.4, 8.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLength of cancer in biopsy, mm\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e7 (4, 14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e8 (4, 16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e8 (4, 17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e7 (3, 15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e8 (4, 16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Missing (n)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e146\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eProstate weight, g\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e40 (33, 50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e44 (36, 56)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e43 (35, 52)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e44 (36, 54)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e42 (34, 53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Missing (n)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOperation time, min\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e165 (141, 193)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e196 (154, 247)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e115 (78, 158)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e94 (75, 135)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e181 (151, 219)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Missing (n)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e180\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e320\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e461\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLymph node dissection performed, number (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e22 (2.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e116 (8.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e67 (5.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e92 (11%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e113 (4.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIntraoperative bleeding, ml\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e100 (50, 200)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e200 (100, 500)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e250 (100, 550)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e550 (350, 800)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e100 (50, 200)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Missing (n)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e153\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e185\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSurgeon experience, number\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e181 (103, 290)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e152 (71, 310)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e241 (110, 818)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e511 (126, 1,153)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e162 (81, 283)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Missing (n)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBCR,\\u0026nbsp;n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e173 (19%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e360 (27%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e252 (22%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e195 (23%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e590 (23%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Missing (n)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAll-cause mortality, \\u0026nbsp;n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e41 (4.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e96 (7.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e78 (6.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e66 (7.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e149 (5.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eProstate cancer specific mortality, n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e10 (1.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e23 (1.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e28 (2.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e22 (2.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 94px;\\\"\\u003e\\n \\u003cp\\u003e39 (1.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eThere was an association between adverse events during radical prostatectomy and all-cause mortality (HR 1.46; CI 1.0 \\u0026ndash; 2.12; p \\u0026lt;0.05) looking at the entire cohort and the combination of all seven types of adverse events (Table 2). Adverse events were not associated with prostate cancer specific mortality (Supplement Table 3).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eTable 2.\\u003c/em\\u003e Association between adverse events during surgery and recurrence within 8 years of surgery\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"511\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eAny type of surgery\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHazard ratio\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;95% CI\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCombined adverse events group 1-7\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCombined adverse events group 2-7\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.22\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1 Operating time \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.88\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e0.31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2 Perioperative bleeding \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e2.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e3 Cutting anastomotic suture/s \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.80\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e0.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e4 Difficult dissection \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.34\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e5 Any defined problem \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e0.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e6 Adhesiolysis \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e0.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 236px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e7 Other \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.72\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 82px;\\\"\\u003e\\n \\u003cp\\u003e0.51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"511\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u0026nbsp;Open radical prostatectomy (ORP)\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHazard ratio\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;95% CI\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; p- value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCombined adverse events group 1-7\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCombined adverse events group 2-7\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e3.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e15.25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1 Operating time\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2 Perioperative bleeding\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e2.19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e3.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e3 Cutting anastomotic suture/s\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e2.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e4 Difficult dissection\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e5.25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e5 Any defined problem\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e2.20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e6 Adhesiolysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 255px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e7 Other\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e4.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"510\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eRobot assisted laparoscopic radical prostatectomy (RALP)\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHazard ratio\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;95% CI\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; p- value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCombined adverse events group 1-7\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.42\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.74\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCombined adverse events group 2-7\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.71\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1 Operating time\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.85\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2 Perioperative bleeding\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e2.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e3 Cutting anastomotic suture/s\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.74\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e4 Difficult dissection\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e5 Any defined problem\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.42\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e6 Adhesiolysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e7 Other\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e2.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eAdjusted for\\u0026nbsp;clinical T stage, preoperative PSA, Gleason score on biopsy and prostate weight\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e1\\u003c/sup\\u003eIndicates confidence interval\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e2\\u003c/sup\\u003eNot analyzed due to missing values\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eTable 3.\\u003c/em\\u003e Association between adverse events during radical prostatectomy and all-cause mortality.\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"510\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHazard ratio\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 128px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95% CI\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep- value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCombined adverse events group 1-7\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e2.12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.049\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCombined adverse events group 2-7\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.42\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e2.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1 Operating time \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.87\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2 Perioperative bleeding \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e2.74\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e3 Cutting anastomotic suture/s \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e4 Difficult dissection \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e5 Any defined problem \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e1.27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e1.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e6 Adhesiolysis \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.88\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e2.74\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 254px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e7 Other \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.09\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 71px;\\\"\\u003e\\n \\u003cp\\u003e4.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e0.65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eAdjusted for\\u0026nbsp;clinical T stage, preoperative PSA, Gleason score on biopsy and prostate weight\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e1\\u003c/sup\\u003eIndicates confidence interval\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eWe identified pre- or perioperative risk factors for adverse events during surgery (Table 4), where age at surgery (OR 1.34; CI 1.00 \\u0026ndash; 1.55), BMI (OR 1.95; CI 1.43 - 2.71), prostate weight (OR 1.38; CI 1.22 \\u0026ndash; 1.54), TUR-P (OR 3.7; CI 1.82 \\u0026ndash; 9.53), prior abdominal surgery (OR 1.31; CI 1.00 \\u0026ndash; 1.75), teaching during surgery (OR 1.3; CI 1.00 \\u0026ndash; 1.58), and lymph node dissection (OR 4.72; CI 2.75 \\u0026ndash; 8.61) were variables of importance (VIF). When removing operating time from the equation teaching disappeared as a variable of importance ( Table 4).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eTable 4.\\u003c/em\\u003e Risk factors for adverse events, combined group 1-7 and combined group 2-7.\\u003c/p\\u003e\\n\\u003cdiv align=\\\"\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"602\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ecombined 1-7\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 243px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ecombined 2-7\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRisk factor\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVIF\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOR\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95% CI\\u003csup\\u003e3\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVIF\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOR\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95% CI\\u003csup\\u003e3\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e96\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1.34\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1, 1.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1.28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e1.13, 1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBMI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1.95\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1.43, 2.71\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e1.55, 2.72\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePrevious TUR-P\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e3.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1.82, 9.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e2.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e1.56, 5.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePrevious abdominal surgery\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1.31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1, 1.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e80\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1.32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e1, 1.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ecT\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e0.84, 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e0.87, 1.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePreop_Gleason_score\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1, 1.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e0.63, 1.43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eProstate_weight\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1.38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1.22, 1.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e1.24, 1.51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLymph_node dissection\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e4.72\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e2.75, 8.61\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e2.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e1.52, 3.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSurgeon experience\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1, 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e1, 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTeaching in OR\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1, 1.58\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e0.9, 1.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eAdjusted for\\u0026nbsp;clinical T stage, preoperative PSA, Gleason score on biopsy and prostate weight\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e1\\u003c/sup\\u003eVIF: variable of importance. In 100 simulations, the variable was selected this number of times in the model.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e2\\u003c/sup\\u003eIndicates Odds Ratio\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e3\\u003c/sup\\u003eIndicates confidence interval\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eAdverse events during radical prostatectomy for prostate cancer were associated with an increased risk for recurrence. Specifically, three of the defined adverse events, perioperative bleeding, difficulty at dissection and reporting \\u0026ldquo;any defined problem during surgery\\u0026rdquo; were separately related to increased risk for recurrent disease.\\u003c/p\\u003e \\u003cp\\u003eAn association between intraoperative adverse events and local recurrence within five years after surgery for rectal cancer has been reported (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e) and adverse events after abdominal surgery have reportedly been associated with a higher risk of postoperative mortality, morbidity and increased postoperative length of stay (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eWe identified several preoperative risk factors for adverse events during surgery. Knowledge about such risk factors could be one basis in the preoperative discussion between patient and surgeon to plan the extent of surgery such as with/without lymph node dissection or just to increase surgeon\\u0026rsquo;s awareness about possible adverse events and the. The list of adverse events expressed as questions in the clinical record form (CRF) filled out by the surgeons at the time of the surgery, included objective measures. Several questions had answer alternatives Yes or No, without follow up questions about extent. Other questions represented subjective experiences such as cutting stitch (meaning stitch cutting through urethra or bladder neck during the anastomosis), difficulty during dissection, any problem during the operation, all answered by Yes/No. Regarding a cutting stitch this most often reflects increased tension in the anastomosis. Usually another stitch is placed and there is no need to take down the whole anastomosis. However we do not have the exact information for each patient about consequences of a cutting stich. As the answers to questions about experiences described above were categorical it is not possible to extend analyses to how much or how difficult. There is as always a balance between number of questions, degree of details covered and compliance in filling out the questionnaire.\\u003c/p\\u003e \\u003cp\\u003eDissection difficulties were associated with recurrence in the robot operated group and for the entire cohort. Part of the explanation for the somewhat diverse findings could be lack of power, as number of events decreased with subgrouping, especially in the openly operated group. Extensive blood loss during surgery was associated with recurrence also in the subgroups, and this is an indication that this association was not technique specific. Importantly it should be noted that we defined \\u0026ldquo;blood loss\\u0026rdquo; as the top 10% percentile of perioperative bleeding for each technique and as blood loss was significantly smaller in RALP compared with ORP \\u0026ldquo;extensive blood loss volume\\u0026rdquo; was different in the two techniques. We suggest that blood loss, defined as the top 10% percentile represents technical difficulties during the surgical procedure rather than the actual volume of blood lost. \\u0026ldquo;Dissecting difficulties\\u0026rdquo; and \\u0026ldquo;Any defined problem during surgery\\u0026rdquo; were also associated with worse oncological outcome which would suggest that our interpretation of a mediation between excessive blood loss and oncological outcome could be correct, that the blood loss should be regarded as proxy for difficulties during surgery. Although adverse events and risk factors were associated with higher risk of recurrence, the analyses of mortality suffer from lack of power due to the restricted number of events (deaths) (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eWe have earlier described an inverse relationship between surgeon satisfaction measured directly after the operation and intraoperative events such as technical difficulties and intraoperative complications as described by the surgeon at the time (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). The present results add important knowledge regarding the implication of intraoperative events for oncological outcomes. It could be suggested that surgeon satisfaction could be a relevant quality outcome of radical prostatectomy. Whether surgeon dissatisfaction could be used as \\u0026ldquo;proxy\\u0026rdquo; for a need for more frequent follow-up, would need further studies.\\u003c/p\\u003e \\u003cp\\u003eOur results suggest that all possible pre- and perioperative measures to reduce bleeding should be undertaken, such as checking medications preoperatively and immediately respond to perioperative bleeding with the aim to control. We have earlier reported a difference regarding perioperative blood loss volume between the two techniques, in favor of RALP (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e), similar to most reports about laparoscopic surgery regardless of type of procedure (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). This phenomenon has been attributed in part to the necessity to perform \\u0026ldquo;bloodless surgery\\u0026rdquo; as bleeding during any type of laparoscopy results in decreased visibility. Another hypothesis is that the positive pressure inside the abdominal cavity during any laparoscopic procedure, by the insufflation of carbon dioxide at a positive pressure, will overcome the pressure in venules/small veins and thus result in a rapid cessation of small bleeding points. Still our results indicate that it is not only the blood loss (volume) itself as it was the relative increase of blood loss that increased the risk for recurrence.\\u003c/p\\u003e \\u003cp\\u003eAwareness that age is a risk factor could indicate the need for re-consideration of surgery as primary treatment in certain cases, but more often in efforts to optimize the patient while waiting for surgery as well as optimizing the operation as such. The adverse event \\u0026ldquo;difficulties at dissection\\u0026rdquo; could possibly be counteracted by considering a \\u0026ldquo;two surgeon principle\\u0026rdquo;, a routine to ensure experience but at the same time to increase experience by using one procedure to increase experience for two surgeons (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eStrengths in this study included the intraoperative clinical record form filled out by the operating surgeon, in immediate connection with the operation. The recording of adverse events is both systematic and detailed, and in combination with immediate reporting could be taken as an indication of high validity of data, compared with retrospective study designs using medical records (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e). Further strengths were the cohort size as well as the multicenter design. The lack of established definitions of the various adverse events should be regarded as a limitation, to some extent balanced by distinct questions and answer alternatives in the clinical record form. The non-randomized design is a limitation. Another limitation relates to a low number of events (deaths), particularly in subgroup analyses. A further limitation could be that surgeon experience was not included in the statistical models, neither was center. This study is explorative in nature, and the outcomes were not the primary endpoint of the LAPPRO trial.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eThis explorative study found associations between adverse events during radical prostatectomy and recurrence, and extensive perioperative bleeding, a difficult dissection and other defined problems during the procedure individually were associated with recurrence. Some risk factors for adverse events were identified. An increased awareness that adverse events during surgery relate to oncologic outcome is warranted. Further work would be needed in order to identify factors predictive of surgery without adverse events.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAUTHORS\\u0026acute; CONTRIBUTONS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors contributed to the statistical analysis plan, the interpretation of results and to editing and revising the manuscript and all have approved of the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors have no conflicts of interest to disclose.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eACKNOWLEDGEMENT\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors gratefully acknowledge important contributions from late professor Gunnar Steineck, MD, PhD, to the LAPPRO trial and the plan of analyses for this study. All surgeons who filled out the perioperative CRF are gratefully acknowledged. The authors would like to thank local investigators, Ingrid H\\u0026ouml;glund-Karlsson RN and all research staff for their excellent work.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFUNDING\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was supported by research grants from the Swedish Cancer Society (2008/922, 2010/593, 2013/497, 2016/362, Pj2019 0303, Pj22 2006), The Swedish Research Council (2012-1770, 2015-02483), Region V\\u0026auml;stra G\\u0026ouml;taland, Sahlgrenska University Hospital (ALFBGB grants 13875, 146201, 4307771, 718221, 965245; HTA\\u0026ndash;VGR 6011; agreement concerning research and education of doctors), the Mrs. Mary von Sydow Foundation, and the Anna and Edvin Berger Foundation. The funding sources had no role in the design, analysis, interpretation or writing of the manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eSocialstyrelsen. Statistik om nyuppt\\u0026auml;ckta cancerfall. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/statistik/2022-12-8308.pdf\\u003c/li\\u003e\\n\\u003cli\\u003eBill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in early prostate cancer. \\u003cem\\u003eNew England J Medicine\\u003c/em\\u003e. Mar 06 2014;370(10):932-42. \\u003c/li\\u003e\\n\\u003cli\\u003eBill-Axelson A, Holmberg L, Garmo H, et al. Radical Prostatectomy or Watchful Waiting in Prostate Cancer \\u0026mdash; 29-Year Follow-up. \\u003cem\\u003eNew England J Medicine\\u003c/em\\u003e. 2018;379(24):2319-2329. \\u003c/li\\u003e\\n\\u003cli\\u003eHamdy FC, Donovan JL, Lane JA, et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer.\\u003cem\\u003eNew England J Medicine\\u003c/em\\u003e. 2023 Apr 27;388(17):1547-1558.\\u003c/li\\u003e\\n\\u003cli\\u003eThorsteinsdottir T, Stranne J, Carlsson S, et al. LAPPRO: a prospective multicentre comparative study of robot-assisted laparoscopic and retropubic radical prostatectomy for prostate cancer. \\u003cem\\u003eScandinavian journal of urology and nephrology\\u003c/em\\u003e. Mar 2011;45(2):102-12. \\u003c/li\\u003e\\n\\u003cli\\u003eHaglind E, Carlsson S, Stranne J, et al. Urinary Incontinence and Erectile Dysfunction After Robotic Versus Open Radical Prostatectomy: A Prospective, Controlled, Nonrandomised Trial. \\u003cem\\u003eEuro Urol\\u003c/em\\u003e. Aug 2015;68(2):216-25. doi:10.1016/j.eururo.2015.02.02910.1016/j.eururo.2015.02.029. Epub 2015 Mar 12.\\u003c/li\\u003e\\n\\u003cli\\u003eLantz A, Bock D, Akre O, et al. Functional and Oncological Outcomes After Open Versus Robot-assisted Laparoscopic Radical Prostatectomy for Localized Prostate Cancer: 8-Year Follow-up. \\u003cem\\u003eEuro Urol\\u003c/em\\u003e. Nov 2021;80(5):650-660. doi:10.1016/j.eururo.2021.07.02\\u003c/li\\u003e\\n\\u003cli\\u003eNyberg M, Hugosson J, Wiklund P, et al. Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial. \\u003cem\\u003eEur Urol Oncol\\u003c/em\\u003e. Oct 2018;1(5):353-360. doi:10.1016/j.euo.2018.04.012\\u003c/li\\u003e\\n\\u003cli\\u003eAx\\u0026eacute;n E, Godtman RA, Bjartell A, et al. Degree of Preservation of Neurovascular Bundles in Radical Prostatectomy and Recurrence of Prostate Cancer. \\u003cem\\u003eEur Urol Open Sci\\u003c/em\\u003e. Aug 2021;30:25-33. \\u003c/li\\u003e\\n\\u003cli\\u003eAntonio Benito Porcaro, Alberto Bianchi, Sebastian Gallina et al. Advanced age portends poorer prognosis after radical prostatectomy: a single center experience. \\u003cem\\u003eAging Clinical and Experimental Research\\u003c/em\\u003e (2022) 34:2857\\u0026ndash;2863\\u003c/li\\u003e\\n\\u003cli\\u003eSooriakumaran P, Ploumidis A, Nyberg T, et al. The impact of length and location of positive margins in predicting biochemical recurrence after robot-assisted radical prostatectomy with a minimum follow-up of 5 years. \\u003cem\\u003eBJU international\\u003c/em\\u003e. Jan 2015;115(1):106-13. \\u003c/li\\u003e\\n\\u003cli\\u003eTewari A, Sooriakumaran P, Bloch DA, et al. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. \\u003cem\\u003eEuro Urol\\u003c/em\\u003e. Jul 2012;62(1):1-15.\\u003c/li\\u003e\\n\\u003cli\\u003eWaldenstedt S, Bock D, Haglind E, et al. Intraoperative adverse events as a risk factor for local recurrence of rectal cancer after resection surgery. \\u003cem\\u003eColorectal Dis\\u003c/em\\u003e. 2022 Apr;24(4):449-460. \\u003c/li\\u003e\\n\\u003cli\\u003eBohnen JD, Mavros MN, Ramly EP, et al. Intraoperative Adverse Events in Abdominal Surgery: What Happens in the Operating Room Does Not Stay in the Operating Room. \\u003cem\\u003eAnn Surg\\u003c/em\\u003e. Jun 2017;265(6):1119-1125.\\u003c/li\\u003e\\n\\u003cli\\u003eWallerstedt A, Tyritzis SI, Thorsteinsdottir T, et al. Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy. Eur Urol. 2015 Apr;67(4):660-70.\\u003c/li\\u003e\\n\\u003cli\\u003eErestam S, Bock D, Erichsen Andersson A, et al. Associations between intraoperative factors and surgeons\\u0026apos; self-assessed operative satisfaction. \\u003cem\\u003eSurg Endosc.\\u003c/em\\u003e 2020 Jan;34(1):61-68. \\u003c/li\\u003e\\n\\u003cli\\u003eVeldkamp R, Kuhry E, Bonjer HJ,et al . Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. \\u003cem\\u003eLancet Oncol\\u003c/em\\u003e 2005;6(7):477-84\\u003c/li\\u003e\\n\\u003cli\\u003evan der Pas MH, Haglind E, Cuesta MA,et al . Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. \\u003cem\\u003eLancet Oncol\\u003c/em\\u003e 2013;14(3):210-8\\u003c/li\\u003e\\n\\u003cli\\u003eMatsuura N, Igai H, Ohsawa F, Numajiri K, Kamiyoshihara M. Learning curve for uniportal thoracoscopic pulmonary segmentectomy: how many procedures are required to acquire expertise?\\u003cem\\u003eTransl Lung Cancer Res.\\u003c/em\\u003e 2023 Jul 31;12(7):1466-1476\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"world-journal-of-urology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"wjur\",\"sideBox\":\"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)\",\"snPcode\":\"345\",\"submissionUrl\":\"https://submission.nature.com/new-submission/345/3\",\"title\":\"World Journal of Urology\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"Adverse events, Prostate cancer, Surgical technique, Radical prostatectomy, Risk factors, Oncological outcomes\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6716233/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6716233/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eObjective\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe objective was to explore if adverse events during radical prostatectomy for prostate cancer were associated with the oncological outcomes recurrence, all-cause and prostate cancer specific mortality. One further was to identify risk factors for adverse events.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA post-hoc study nested in a prospective, controlled trial of radical prostatectomy by robot assisted laparoscopic or open retropubic approach in Sweden. Adverse events during surgery were collected by clinical record forms (CRFs) filled out by the surgeon at operation. Recurrence was identified by CRFs and patient reports, cause of death through the Swedish National Cause of Death register. Recurrence was defined as undetectable PSA 6-12 weeks after prostatectomy followed by PSA \\u0026gt;0.25 ng/ml or treatment for prostate cancer recurrence. Cox regression was used to explore associations between exposure and outcome.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOne/more adverse events occurred during 39% (1356/ 3444) of operations. \\u0026nbsp;Adverse events were associated with recurrence, but not with all-cause or prostate cancer specific mortality. Intraoperative extensive bleeding and difficulties during dissection were associated with recurrence. Risk factors included age at surgery, history of TUR-P or abdominal surgery, teaching, prostate weight and lymph node dissection.\\u003c/p\\u003e\\n\\u003cp\\u003eLimitations included the low number of observations (deaths), particularly in subgroup analyses and hospital volume. This study should be regarded as explorative.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAdverse events during radical prostatectomy were associated with increased risk for recurrence. Intraoperative bleeding and difficulties during dissection were individual risk factors for recurrence. Risk factors for adverse events were age, prostate weight, prior abdominal surgery and lymph node dissection.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Adverse Events During Radical Prostatectomy and Their Association With Reccurence and Death\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-06-16 12:02:09\",\"doi\":\"10.21203/rs.3.rs-6716233/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-07-22T14:15:12+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-06-19T08:42:57+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"301732495378260657834207187478650943394\",\"date\":\"2025-06-12T05:59:18+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-06-11T13:35:28+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-06-10T14:43:07+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-06-10T13:29:51+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"World Journal of Urology\",\"date\":\"2025-05-21T11:40:56+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"world-journal-of-urology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"wjur\",\"sideBox\":\"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)\",\"snPcode\":\"345\",\"submissionUrl\":\"https://submission.nature.com/new-submission/345/3\",\"title\":\"World Journal of Urology\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"a294e7f0-2a8d-4f58-869a-fd278d108ca3\",\"owner\":[],\"postedDate\":\"June 16th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-09-29T16:01:04+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-6716233\",\"link\":\"https://doi.org/10.1007/s00345-025-05932-7\",\"journal\":{\"identity\":\"world-journal-of-urology\",\"isVorOnly\":false,\"title\":\"World Journal of Urology\"},\"publishedOn\":\"2025-09-23 15:57:12\",\"publishedOnDateReadable\":\"September 23rd, 2025\"},\"versionCreatedAt\":\"2025-06-16 12:02:09\",\"video\":\"\",\"vorDoi\":\"10.1007/s00345-025-05932-7\",\"vorDoiUrl\":\"https://doi.org/10.1007/s00345-025-05932-7\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6716233\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6716233\",\"identity\":\"rs-6716233\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}