Post Date December, 03 2023
Compared with patients who underwent retropubic radical prostatectomy (rrp), patients who underwent minimally invasive radical prostatectomy (mirp) had shorter hospital stay and less intraoperative bleeding.
On the contrary, patients undergoing minimally invasive surgery have more urinary incontinence and erectile dysfunction. The research results were published in the Jama magazine published on October 14.
There was no significant difference between the two groups of patients undergoing open surgery and minimally invasive surgery in terms of survival rate or the need for other tumor treatment, reported Dr. Jimc.hu and colleagues from Brigham and Women's Hospital in Boston, United States.
At the press conference, when asked whether minimally invasive surgery was over-publicized to medical consumers, Dr. Hu said: "That's what I want to say from our research findings."
This observational study is based on data from the "surveillance, epidemiology and final results (seer)" registry (2003-2007) of the American Medical Insurance (Medicare) and the American Society of Oncology.
The study evaluated the prognosis of 8837 patients with prostate cancer aged 65 years and above, of which 22% received mirp treatment and 78% received rrp operation. Several mirp operations were performed with the help of robots, but the researchers did not know the exact number of cases, because all robot operations did not have a separate universal medical procedure (cpt) code.
From 2003 to 2007, the application of mirp increased almost fivefold, from 9.2% to 43.2% of all surgical operations, which is also a reflection of the market promotion of non-invasive and robotic surgery (Jama 2009; 302:1557-64).
When analyzing the incidence of complications, the researcher adjusted the operation year, age, comorbidity, baseline urinary incontinence and erectile dysfunction, race, marital status, educational background, income level, seer area, population density, pathological grade and stage.
After adjusting for 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. The other indicators of mirp operation were 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 had fewer urogenital complications (4.7% vs 2.1%). In particular, it should be pointed out that the incidence of incontinence [15.9 cases/(100 person-years) vs 12.2 cases/(100 person-years)] and erectile dysfunction [26.8 cases/(100 person-years) vs 19.2 cases/(100 person-years)] in the rrp group is lower.
The researchers pointed out that the commercial advertisements and market promotion that are conducive to robot-assisted mirp surgery may have a negative impact on the publication of relevant literature that describes this operation in detail. They wrote: "Until the comparative efficacy of robot-assisted mirp is confirmed, compared with mirp, as the surgical method leading for 20 years, rrp is still the preferred surgical treatment for localized prostate cancer."
The research was funded by the Ministry of Defense Prostate Cancer Doctor Training Award awarded by Dr. Hu.
Dr. Hu did not issue a statement of interest, but one of his co-authors, Dr. Michael j. Barry, from Massachusetts General Hospital in Boston, said that he was funded as the chairman of the foundation for informed medical decision making.
