CHICAGO -- October 13, 2009 -- New research indicates that the use of minimally invasive procedures for radical prostatectomy may shorten hospital stays and decrease respiratory and surgical complications, but may also result in an increased rate of certain complications, including incontinence and erectile dysfunction.
The study was published in the October 14 issue of JAMA and the findings were presented at a JAMA media briefing in Chicago by lead author Jim C. Hu, MD, Brigham and Women's Hospital, Boston, Massachusetts.
Minimally invasive radical prostatectomy (MIRP), in particular with the use of robotic assistance, has increased from 1% to 40% of all radical prostatectomies from 2001 to 2006, according to background information in the article. But this rapid increase has occurred despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP).
"Moreover, the widespread direct-to-consumer advertising and marketed benefits of robotic-assisted MIRP in the United States may promote publication bias against studies that detail challenges and suboptimal outcomes early in the MIRP learning curve. Until comparative effectiveness of robotic-assisted MIRP can be demonstrated, open RRP, with a 20-year lead time for dissemination of surgical technique relative to MIRP, remains the gold standard surgical therapy for localised prostate cancer," the authors wrote.
Dr. Hu and colleagues assessed the outcomes for men with prostate cancer who underwent MIRP (n = 1,938) versus RRP (n = 6,899), using US Surveillance, Epidemiology, and End Results Medicare linked data. During the study period, the use of MIRP increased almost 5-fold, from 9.2% in 2003 to 43.2% in 2006-2007.
After analyses, the researchers found that men undergoing MIRP versus RRP experienced shorter hospital length of stay (median 2.0 vs 3.0 days), were less likely to receive transfusions (2.7% vs 20.8%), and were at lower risk of postoperative respiratory complications (4.3% vs 6.6%) and miscellaneous surgical complications (4.3% vs 5.6%).
"However, men undergoing MIRP versus RRP experienced more genitourinary complications (4.7% vs 2.1%) and were more often diagnosed as having incontinence and erectile dysfunction. The need for additional cancer therapies was similar by surgical approach," the authors wrote.
The researchers also found that greater receipt of MIRP versus RRP was associated with living in areas of higher socioeconomic status based on education and income, and that this may be the result of a "highly successful robotic-assisted MIRP marketing campaign disseminated via the Internet, radio, and print media channels likely to be frequented by men of higher socioeconomic status."
"In light of the mixed outcomes associated with MIRP, our finding that men of higher socioeconomic status opted for a high-technology alternative despite insufficient data demonstrating superiority over an established gold standard may be a reflection of a society and healthcare system enamored with new technology that increased direct and indirect health care costs but had yet to uniformly realise marketed or potential benefits during early adoption," the authors concluded.
SOURCE: JAMA
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