minimally invasive surgery







01 Decenber 2009

Comparative effectiveness of minimally invasive vs open radical prostatectomy

Statistics show that minimally invasive radical prostatectomy (MIRP) for prostate cancer treatment is the most common therapy for localized prostate cancer (CaP) in the United States. The popularity of this treatment in part is due to marketing and patient driven desire for the procedure. This encompasses both pure laparoscopic radical prostatectomy and robotic-assisted radical prostatectomy.

In the October 14, 2009 issue of the Journal of the American Medical Association, a scientific team compares outcomes of minimally invasive surgery and RP using the SEER database.

A total of 8,837 men met inclusion criteria for having undergone radical prostatectomy between 2002 and 2005, with follow-up through 2007. RP was performed in 6,899 and MIRP in 1,938 patients.

After comparing post-operative outcomes, it was found that minimally invasive surgery vs. radical prostatectomy patients had a shorter length of stay, less likely to have a blood transfusion, less likely to have postoperative respiratory complications, and less likely to have anastomotic stricture.

On the other hand, minimally invasive surgery patients had more genitourinary complications compared with RP men. This included incontinence and erectile dysfunction. As a surrogate for oncologic outcome, the need for additional cancer treatment was similar for MIRP and RP.

This study presents an important message in that the urologic community did not prospectively compare major forms of options in prostate cancer treatment. However, the data has limitations. For example, during the study time frame, adjuvant radiation therapy was not a standard and secondary cancer treatments may not necessarily correlate with positive surgical margin rates.

The study controlled for surgeon but not hospital volumes, both known to correlate with outcomes. In every SEER area, more RPs were performed than MIRPs, despite MIRPs presently outnumbering RPs in the US. This shows that MIRP was clearly in its infancy and learning curve across the US and may not reflect present outcomes. The authors attempted to control for this by adjusting for year of surgery.



NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment.





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