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Comparative Effectiveness Of Minimally Invasive Vs Open Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Cancer / Oncology | Urology / Nephrology
Article Date: 29 Nov 2009

UroToday.com - Minimally invasive radical prostatectomy (MIRP) for prostate cancer (CaP) is the most common treatment modality for localized CaP in the United States. The popularity in part is due to marketing and patient driven desire for the procedure. This encompasses both pure laparoscopic radical prostatectomy and robotic-assisted radical prostatectomy.

No randomized trial has compared it with open radical retropubic prostatectomy (RP). In the October 14, 2009 issue of the Journal of the American Medical Association, Dr. Jim Hu and colleagues compare outcomes of MIRP and RP using the SEER database.

A total of 8,837 men met inclusion criteria for having undergone radical prostatectomy between 2002 and 2005, with follow-up through 2007. RP was performed in 6,899 and MIRP in 1,938 patients. Post-operative outcomes were compared. There was a 5-fold increase in the use of MIRP during the study period (9.2% to 43.2%). African-American and Hispanic men were more likely to undergo RP than MIRP, but the opposite was the case for Asian men. MIRP patients were more likely to reside in areas of higher educational and financial status.

MIRP vs. RP patients had a shorter length of stay (2.0 vs. 3.0 days), less likely to have a blood transfusion (2.7% vs. 20.8%), less likely to have postoperative respiratory complications (4.3% vs. 5.6%), and less likely to have anastomotic stricture (5.8% vs. 14.0%). MIRP patients had more genitourinary complications compared with RP men (4.7% vs. 2.1%). This included incontinence (15.9 vs. 12.2 per 100 person years), and erectile dysfunction (26.8 vs. 19.2 per 100 person years). As a surrogate for oncologic outcome, the need for additional cancer treatment was similar for MIRP and RP (8.2 vs. 6.9 per 100 person-years).

This study presents an important message in that the urologic community did not prospectively compare major forms of CaP treatments. However, the data has limitations. For example, during the study time frame, adjuvant radiotherapy was not a standard and secondary cancer treatments may not necessarily correlate with positive surgical margin rates.

The study controlled for surgeon but not hospital volumes, both known to correlate with outcomes. In every SEER area, more RPs were performed than MIRPs, despite MIRPs presently outnumbering RPs in the US. This shows that MIRP was clearly in its infancy and learning curve across the US and may not reflect present outcomes. The authors attempted to control for this by adjusting for year of surgery.

Hu JC, Gu X, Lipsitz SR, Barry MJ, D'Amico AV, Weinberg AC, Keating NL
JAMA. 2009 Oct 14;302(14):1557-64

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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Comparative Effectiveness Of Minimally Invasive Vs Open Radical Prostatectomy

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