Less Invasive Prostate Removal Safer than Traditional Surgery
Minimally-invasive radical prostatectomy (MIRP) proves safer than traditional open surgery—resulting in fewer post-surgical complications, fewer blood transfusions, and shorter hospital stays, according to the results of a study published in European Urology.
Radical prostatectomy refers to the surgical removal of the entire prostate and some surrounding tissue. Prostatectomy may be performed using traditional open surgery, in which the surgeon makes a single, long incision, or through a laparoscopic procedure (sometimes called minimally invasive surgery), in which several small incisions are made. During laparoscopy, the surgeon inserts a small video camera through one of the incisions in order to see inside the abdomen. In a variant of laparoscopic surgery known as robotic-assisted laparoscopic surgery, the surgeon sits at a console near the operating table and performs the surgery by controlling robotic arms that hold the surgical instruments.
This study evaluated data from 78,232 men over age 65 who underwent prostate removal between 2003 and 2007. What makes this study unique, however, is that it included the data from 100% of Medicare patients in the United States—resulting in a comprehensive body of data that reflects results from both large and small communities from every region of the country. The large sample size enabled researchers to detect statistically significant differences in outcomes between the two methods that smaller studies might not have captured.
During the study period, 19,594 men underwent MIRP with either laparoscopy or robotic technology and 58,638 men underwent traditional open surgery (retropubic radical prostatectomy, or RRP). The use of MIRP increased during the study period—at the beginning, it was used in fewer than 5% of cases, but by the end of the study period, it was used 44.5% of the time. In contrast, the use of RRP decreased from 89.4% in 2003 to 52.9% in 2007.
The researchers found that MIRP was associated with fewer post-surgical complications, fewer blood transfusions, and shorter hospital stays. What’s more—they discovered that post-surgical complications decreased over time in the MIRP group and increased over time in the RRP group. Complication risks in the RRP group increased from 27.4% to 32% and included a significant increase in post-surgical death from 0.5% to 0.8%. Men in the MIRP group had a 0.2% risk of post-surgical death compared to 0.6% for men in the RRP group. The risk of death was small in both groups; however, this was a statistically and potentially clinically significant difference between the two groups.
The researchers concluded that between 2003 and 2007, men who underwent MIRP had fewer blood transfusions, fewer genitourinary complications, and fewer surgical complications compared to their counterparts who underwent RRP. Furthermore, RRP was associated with more post-operative mortality and complications.
Men with prostate cancer are encouraged to speak with their physician to safely evaluate the risks and benefits of the different surgical procedures.
 Kowalczyk KJ, Levy JM, Caplan CF, et al. Temporal national trends of minimally invasive and retropubic radical prostatectomy outcomes from 2003 to 2007: Results from the 100% Medicare Sample. European Urology. 2012; 61: 803-809.
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