Surgical Approaches for Prostate Cancer Comparable

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Open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) have similar rates of post-operative morbidity, according to a new study.


The only differences favoring LRP were shorter hospital stays and a lower risk of bladder neck or urethral obstruction, researchers reported. 


Enthusiasm for LRP, particularly for robotic-assisted procedures, has grown significantly in recent years due to marketing and advertising campaigns, despite limited evidence of its superiority to ORP.


The study included 5,923 men who had prostate surgery from 2003 to 2005. Of these, 4,858 (82%) had an ORP and 1,065 (18%) underwent LRP. These men were part of the Surveillance, Epidemiology and End Results (SEER)-Medicare data set.

All were aged 66 years or older with localized prostate cancer. Outcome measures included general medical and surgical complications and mortality within 90 days after surgery, genitourinary and bowel complications within 365 days, and the need for radiation therapy and/or androgen deprivation therapy (ADT) within 365 days, and length of hospital stay.


In both groups, the 90-day all-
cause mortality rate was 0.5%, the researchers reported in the Journal of Urology (published online ahead of print). A general medical or surgical complication occurred within 90 days after surgery in 24% and 21% of ORP and LRP patients, respectively, a nonsignificant difference between the groups.

At one year, 35% and 40% of ORP and LRP patients, respectively, had a genitourinary or bowel complication. Approximately 29% of patients in each group had a Medicare claim related to bladder neck or urethral obstruction. After controlling for patient and tumor characteristics, LRP was associated with a significant 26% decreased risk of these complications.


In addition, about 12% of ORP patients and 9% of men treated with LRP received radiation therapy and/or ADT in the year following surgery.


The LRP group had a median hospital length of stay of 2.0 days compared with 3.0 days for the ORP group, a significant between-group difference.


In the LRP group, the team found that higher surgeon volume was significantly associated with a shorter length of stay and lower rate of bladder neck and urethral obstruction, but not with general medical or surgical complications.


"I suspected that the two techniques would be comparable. So I was not surprised by the findings," said lead study investigator William Lowrance, MD, 
a surgical fellow and clinical instructor at Memorial Sloan-Kettering Cancer Center in New York. "I think the im-portant thing is that there are not any big outcome differences between the different techniques, and patients need to know that. They need to make decisions based on the best evidence that is available."


Marketing and advertising campaigns have created false expectations for some patients, Dr. Lowrance said. "One study, in particular, showed a higher regret or dissatisfaction rate after robotic-assisted laparoscopic surgery and I think it is related to patients having false expectations about what the robot can and cannot do."


Dr. Lowrance noted that his study had limitations. For example, the robotic-assisted laparoscopic procedure has matured somewhat over the past three years, but the SEER-Medicare data set included men treated before 2006. n


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