Minimally Invasive Surgery for Prostate Cancer Increasing, Offers Better Results
Use of minimally invasive radical prostatectomy (MIRP) for patients with prostate cancer (PCa) increased and the use of retropubic radical prostatectomy (RRP) decreased significantly from 2003 to 2007, a study found.
The study, led by Jim C. Hu, MD, of Brigham and Women's Hospital in Boston, found that MIRP was associated with a decreased risk of postoperative mortality and complications compared with RRP, according to an online report in European Urology.
From 2003 to 2007, the use of MIRP increased from 4.9% to 44.5% of radical prostatectomies and the use of RRP declined from 89.4% to 52.9%, the investigators found. Among patients undergoing MIRP, genitourinary complications decreased from 6.2% in 2003 to 4.1% in 2007. Miscellaneous surgical complications decrease from 4.7% to 3.7% during that period, the number of transfusions decreased from 3.5% to 2.2%, and the use of postoperative cystography decreased from 40.3% to 34.1%. During the same period, overall RRP perioperative complications increased from 27.4% to 32%. The perioperative mortality rate rose from 0.5% to 0.8%.
In adjusted analyses, RRP was associated with a 2.67 times increased likelihood of death within 30 days, a 60% increased likelihood of perioperative complications, and a 2.5 times increased likelihood of late complications compared with MIRP.
The retrospective, population-based study of Medicare PCa patients included 19,595 men who underwent MIRP and 58,638 men who underwent RRP.
“MIRP utilization has greatly increased, comprising 44.5% of Medicare radical prostatectomies in 2007,” the authors concluded. “From 2003 to 2007, men undergoing MIRP versus RRP experienced fewer perioperative and late complications. Although MIRP complications decreased over the study period, RRP complications increased, and RRP was associated with higher mortality.”