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Minimally
Invasive Radical Prostatectomy shows
advantages, but also certain complications
Newswise — New research indicates that the
use of minimally invasive procedures
(including the use of robotic assistance)
for radical prostatectomy, which have
increased significantly in recent years, may
shorten hospital stays and decrease
respiratory and surgical complications, but
may also result in an increased rate of
certain complications, including
incontinence and erectile dysfunction,
according to a study in the October 14 issue
of JAMA,
a theme issue on surgical care.
Jim C. Hu, M.D., M.P.H., of Brigham and
Women’s Hospital, Boston, presented the
findings of the study at a JAMA media
briefing in Chicago.
Minimally invasive radical prostatectomy (MIRP),
in particular with the use of robotic
assistance, has increased from 1 percent to
40 percent of all radical prostatectomies
from 2001 to 2006, according to background
information in the article.
But this rapid increase has occurred despite
limited data on outcomes and greater costs
compared with open retropubic radical
prostatectomy (RRP; surgery in which an
incision is made in the lower abdomen to
remove the prostate, which is located in the
pelvis behind the pubic bone).
“Moreover, the widespread direct-to-consumer
advertising and marketed benefits of
robotic-assisted MIRP in the United States
may promote publication bias against studies
that detail challenges and suboptimal
outcomes early in the MIRP learning curve.
"Until
comparative effectiveness of
robotic-assisted MIRP can be demonstrated,
open RRP, with a 20-year lead time for
dissemination of surgical technique relative
to MIRP, remains the gold standard surgical
therapy for localized prostate cancer,” the
authors write.
Dr. Hu and colleagues assessed the outcomes
for men with prostate cancer who underwent
MIRP (n = 1,938) vs. RRP (n = 6,899), using
U.S. Surveillance, Epidemiology, and End
Results Medicare linked data. During the
study period, the use of MIRP increased
almost 5-fold, from 9.2 percent in 2003 to
43.2 percent in 2006-2007.
After analyses, the researchers found that
men undergoing MIRP vs. RRP experienced
shorter hospital length of stay (median
[midpoint], 2.0 vs. 3.0 days), were less
likely to receive transfusions (2.7 percent
vs. 20.8 percent), and were at lower risk of
postoperative respiratory complications (4.3
percent vs. 6.6 percent) and miscellaneous
surgical complications (4.3 percent vs. 5.6
percent).
“However, men undergoing MIRP vs. RRP
experienced more genitourinary complications
[involving the genital and urinary organs or
their functions; 4.7 percent vs. 2.1
percent) and were more often diagnosed as
having incontinence and erectile
dysfunction. The need for additional cancer
therapies was similar by surgical approach,”
the authors write.
The researchers also found that greater
receipt of MIRP vs. RRP was associated with
living in areas of higher socioeconomic
status based on education and income, and
that this may be the result of a “highly
successful robotic-assisted MIRP marketing
campaign disseminated via the Internet,
radio, and print media channels likely to be
frequented by men of higher socioeconomic
status.”
“In light of the mixed outcomes associated
with MIRP, our finding that men of higher
socioeconomic status opted for a
high-technology alternative despite
insufficient data demonstrating superiority
over an established gold standard may be a
reflection of a society and health care
system enamored with new technology that
increased direct and indirect health care
costs but had yet to uniformly realize
marketed or potential benefits during early
adoption,” the authors conclude.
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