Post Date December, 03 2023
Compared with patients undergoing retropubic radical prostatectomy (RRP), patients undergoing minimally invasive radical prostatectomy (MIRP) had shorter hospital stays and fewer intraoperative bleeding.
In contrast, patients undergoing minimally invasive surgery have more urinary incontinence and erectile dysfunction. The results of the study were published in the October 14th issue of the journal Jama.
"There was no significant difference in survival or the need for other tumor treatment between the two groups of patients undergoing open surgery and minimally invasive surgery," reported Dr. Jim C. Hu and colleagues from Brigham and Women's Hospital in Boston, USA.
At a press conference, when asked whether minimally invasive surgery has been excessively promoted to medical consumers, Dr. Hu said, "That's exactly what I want to say from our research findings."
This observational study is based on data from Medicare and the American Society of Oncology's "Surveillance, Epidemiology, and End Results" registry (2003-2007).
The study evaluated the prognosis of 8837 patients with prostate cancer aged 65 years or older, with 22% receiving mirp treatment and 78% receiving rrp surgery. Several mirp operations were performed with robot assistance, but researchers are not aware of the exact number of cases because all robot operations do not have a separate common medical procedure (cpt) code.
Between 2003 and 2007, the application of mirp increased almost fivefold, from 9.2% to 43.2% of all surgical procedures. This is also a reflection of the strong market promotion of non-invasive and robotic surgery (Jama 2009; 302:1557-64).
In analyzing the incidence of complications, the researchers adjusted for surgical year, age, comorbidity, baseline urinary incontinence and erectile dysfunction, race, marital status, educational background, income level, seer region, population density, pathological grade, and stage.
After adjusting for many of the above factors, the researchers found that the median hospital stay was 2 days in the mirp group and 3 days in the rrp group. Other indicators for which mirp surgery is dominant include patients requiring blood transfusion (2.7% vs 20.8%), anastomotic stenosis (5.8% vs 14%), and respiratory complications (4.3% vs 6.6%).
On the other hand, patients receiving RRP treatment have fewer urinary and reproductive system complications (4.7% vs 2.1%). In particular, it should be noted that the incidence of incontinence [15.9 cases/(100 person year) vs 12.2 cases/(100 person year)] and erectile dysfunction [26.8 cases/(100 person year) vs 19.2 cases/(100 person year)] in the RRP group is lower.
Researchers have pointed out that commercial advertising and marketing in favor of robotic assisted mirp surgery may have a negative impact on the publication of relevant literature detailing this operational issue. "Until the comparative efficacy of robotic assisted mirp is confirmed, compared to mirp, which has been leading the surgical approach for 20 years, rrp remains the preferred surgical treatment for localized prostate cancer."
The study was funded by the Defense Department's Prostate Cancer Doctor Training Award, which Dr. Hu received.
Dr. Hu did not issue a statement of interest, but one of his co authors, Dr. Michael J. Barry of Massachusetts General Hospital in Boston, claimed funding as chairman of the Foundation for Informed Medical Decision Making.
