Editor’s Note: The 2025 Pujiang Prostate Cancer Academic Conference—jointly held with the Annual Meeting of the Chinese Society of Clinical Oncology Prostate Cancer Committee (CSCO-PC), the Chinese Anti-Cancer Association Genitourinary Oncology Committee (CACA-GO), and the Chinese Prostate Cancer Consortium (CPCC)—took place in Shanghai on June 27–28. At the conference, Professor Jianming Guo from Zhongshan Hospital, Fudan University, delivered a keynote presentation on “Managing Postoperative Complications After Prostate Cancer Surgery” and later shared additional insights in an interview with Oncology Frontier – UroStream, highlighting Zhongshan’s experience in perioperative enhanced recovery after surgery (ERAS) for prostate cancer patients.01
Oncology Frontier – UroStream Radical prostatectomy may be associated with postoperative complications. In recent years, the ERAS (Enhanced Recovery After Surgery) concept has gained traction. How do you view its value for prostate cancer patients?
Professor Jianming Guo: The ERAS concept involves optimizing perioperative care through preoperative assessment and procedural improvements to minimize both psychological and physiological trauma during surgery and promote faster recovery. Evidence from the literature shows that compared with traditional care, ERAS significantly shortens hospital stays and reduces healthcare costs—without increasing the rate of complications.
At our center, we began applying ERAS principles to radical prostatectomy in 2015. We reduced preoperative fasting time to six hours, encouraged mobilization and oral intake as early as six hours after surgery, and selectively removed drainage tubes within 24 hours postoperatively. In appropriately selected patients, we have also safely removed urinary catheters within 24 hours, without serious complications. These results demonstrate that ERAS is both safe and feasible. It effectively shortens hospital stays and accelerates the return of bowel function, ambulation, and removal of drains.
Moreover, I believe that the most critical factor in successful ERAS implementation is the improvement of surgical techniques and operative approaches. Enhancing surgical proficiency minimizes intraoperative bleeding and shortens anesthesia time, both of which are key to reducing perioperative complications and enabling ERAS protocols. At our center, we can now complete prostate cancer surgeries in under one hour, and the total hospital stay can be reduced to just two to three days—creating optimal conditions for rapid patient recovery.
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Oncology Frontier – UroStream Prostate cancer predominantly affects older adults, who are more susceptible to complications such as cardiopulmonary failure, thrombosis, and bowel obstruction due to age-related decline in organ function. Based on your clinical experience, what key considerations should be kept in mind when treating these patients? How can the risk of complications be minimized?
Professor Jianming Guo: Prostate cancer patients are typically elderly. With the aging population in China, the number of elderly prostate cancer patients has risen significantly in recent years. At the same time, advances in healthcare have led to a growing number of patients presenting with comorbidities involving the heart, lungs, or brain, or with prior abdominal surgical histories. If these patients are not carefully evaluated preoperatively or are not managed appropriately during the perioperative period, they are at substantially higher risk of complications such as cardiopulmonary or cerebrovascular events, deep vein thrombosis (DVT), and bowel obstruction—any of which may result in severe outcomes, including death.
At Zhongshan Hospital, Fudan University—one of China’s largest and most comprehensive tertiary hospitals—our departments of cardiology, respiratory medicine, neurology, anesthesiology, and intensive care medicine are among the top-ranked nationally. We have established a comprehensive system for preoperative evaluation, intraoperative management, and postoperative follow-up in close collaboration with these departments. High-risk patients receive multidisciplinary preoperative assessments and intraoperative care, and those at extremely high risk are transferred to intensive care postoperatively for monitored recovery.
For example, patients with implantable cardioverter-defibrillators (ICDs) often face surgical restrictions due to potential interference from electrocautery devices. However, at our center, we are able to coordinate with cardiologists to disable the defibrillation function prior to surgery. Anesthesiologists monitor and adjust the heart rate intraoperatively, and the device’s functions are restored immediately after surgery. This ensures a smooth and safe perioperative transition, even for high-risk individuals.
To prevent DVT during the perioperative period, all patients undergo a Caprini risk assessment upon admission. We avoid pressure on the popliteal fossa during surgery, and high-risk patients are provided with intermittent pneumatic compression devices. Postoperatively, we initiate ankle-pump exercises in bed and apply graduated compression stockings (GCS). Patients are encouraged to ambulate as early as six hours after surgery, and low-molecular-weight heparin is administered for thromboprophylaxis. We also monitor D-dimer levels postoperatively to detect early signs of thrombosis. As a result of this comprehensive approach, we have had zero cases of fatal pulmonary embolism due to DVT in our department over the past ten years.
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Oncology Frontier – UroStream The management of complications requires multidisciplinary collaboration across urology, rehabilitation, psychology, and more. How does your MDT team integrate postoperative assessment, psychological intervention (especially for anxiety related to sexual dysfunction), and follow-up systems? Could you share a memorable case?
Professor Jianming Guo: Psychological intervention is a crucial component of Enhanced Recovery After Surgery (ERAS). Many patients experience fear and anxiety due to a lack of understanding about their illness and the surgical process, which can negatively impact both the surgery itself and postoperative recovery. Therefore, preoperative psychological assessments are essential. We encourage family members to participate in supporting the patient psychologically and provide educational sessions to ensure that patients have a clear and accurate understanding of their condition and treatment. This reduces anxiety, improves cooperation, and supports faster recovery.
Our team has developed a structured education and rehabilitation program specifically for managing postoperative complications following prostate cancer surgery. Before surgery, patients receive thorough explanations of the procedure and its expected outcomes. We emphasize the importance of early postoperative mobilization and oral intake and clearly communicate the discharge criteria to both patients and their families. Family members are encouraged to support patients during recovery, helping to foster a collaborative healing process. With this approach, patients and families are better prepared, more engaged, and ultimately contribute to improved outcomes.
Additionally, we have published a series of educational materials—popular science articles and books—on prostate cancer, and we continue to promote awareness through public media. These efforts help patients and their families understand the prognosis and potential complications, thereby reducing anxiety. For patients experiencing excessive anxiety, we work closely with the Department of Psychology to provide combined behavioral and pharmacological interventions. This has proven effective in helping patients manage emotions, alleviate anxiety, and reduce surgical fear—yielding very positive outcomes.
