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Does type of surgery make a difference to prostate cancer outcomes?

Posted Feb 23 2010 12:00am

A new analysis of the outcomes of different types of radical prostatectomy appears to show no difference between the patients’ clinical outcomes following laparoscopic (including non-robot-assisted and robot-assisted) categories of surgery (LRP/RALP) and traditional “open” radical retropubic prostatectomy (RRP) when used to treat Medicare patients of 66 years or older.

In this retrospective study, based on patients identified using the SEER-Medicare database, Lowrance et al. identified 5,923 men who had been diagnosed with localized (clinical stage T1-2) prostate cancer and who underwent first-line prostate cancer surgery between 2003 and 2005. Of these 5,923 patients, 4,858 (82 percent) received RRP and 1,065 (18 percent) were treated with LRP/RALP. The majority of the patients were white (85 percent) and aged between 66 and 69 years of age (nearly 60 percent). The full article is scheduled for publication in the April issue of the Journal of Urology.

There is a great deal of important detail available in the full text of this paper, but the major results can be itemized as follows:

  • There were no differences in the rate of general medical/surgical complications between the two types of surgery within 90 days of follow-up.
  • There were no differences in rates of genitourinary/bowel complications within 1 year of follow-up.
  • There were no differences in rates of postoperative radiation therapy and/or androgen deprivation therapy at 1 year of follow-up.
  • LRP/RALP was associated with a 35% reduction in length of hospital stay compared to RRP
  • LRP/RALP was associated with a lower rate of bladder neck/urethral obstruction.

There is considerable controversy within the urology community at this time regarding the “over-adoption” of RALP, and the inaccurate promotion of RALP as being in some way “better” than other forms of radical prostatectomy. The “New” Prostate Cancer InfoLink concurs with both of the two primary conclusions of this paper:

  • “Laparoscopic prostatectomy and open radical prostatectomy have similar rates of postoperative morbidity and additional treatment.”
  • “Men considering prostate surgery should understand the expected benefits and risks of each technique to facilitate decision making and set realistic expectations.”

We would add that, at the end of the day, it is not the type of surgery that is most important, it is the skill and experience of the individual surgeon that is most likely to determine the quality of outcome for the individual patient whether the surgeon uses a robot, a laparoscope, or  just his hands and eyes. It is generally true, however, that laparoscopic forms of surgery (with or without robot assistance) tend to reduce the risk for blood loss during surgery and to reduce the time before the patient can  go home from the hospital compared to open forms of surgery. This study could not assess risk for blood loss during surgery.

An article from HealthDay on this paper appears in BusinessWeek and a media release was issued by the Journal of Urology. The abstract of the actual paper is not yet available on line but a link to the full text of the paper is given within the media release.

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