Radical Prostatectomy A new study signifies that the use of minimally invasive procedures including the utilization of robotic assistance for radical prostatectomy, which have augmented considerably in recent years, may cut down hospital stays and reduce respiratory and surgical complications, but may also lead to an increased rate of particular complications, counting incontinence and erectile dysfunction.

The background information states that minimally invasive radical prostatectomy (MIRP), in particular with the use of robotic assistance, has apparently increased from 1 percent to 40 percent of all radical prostatectomies from 2001 to 2006. But this speedy increase has supposedly taken place in spite of inadequate data on results and larger costs as opposed to open retropubic radical prostatectomy.

The authors commented, “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 localized prostate cancer.”

Jim C. Hu, M.D., M.P.H., of Brigham and Women’s Hospital, Boston, presented the results of the study at a JAMA media briefing in Chicago.

Dr. Hu and colleagues examined the results for men with prostate cancer who underwent MIRP i.e. n = 1,938 vs. RRP i.e. n = 6,899, by using U.S. Surveillance, Epidemiology, and End Results Medicare associated data. Over the course of the study period, the use of MIRP increased almost 5 times, from 9.2 percent in 2003 to about 43.2 percent in 2006-2007.

Post examination, the experts discovered that men going through MIRP vs. RRP experienced shorter hospital stay. The median was 2.0 vs. 3.0 days. They were thought to have lowered chances of bieng given transfusions i.e. 2.7 percent vs. 20.8 percent. They were at lesser danger of postoperative respiratory complications i.e. 4.3 percent vs. 6.6 percent and various surgical complications i.e. 4.3 percent vs. 5.6 percent.

The authors mentioned, “However, men undergoing MIRP vs. RRP experienced more genitourinary complications [involving the genital and urinary organs or their functions; 4.7 percent vs. 2.1 percent) and were more often diagnosed as having incontinence and erectile dysfunction. The need for additional cancer therapies was similar by surgical approach.”

The experts also discovered that superior delivery of MIRP vs. RRP was linked with living in regions of higher socioeconomic status based on education and income, and that this could be the outcome 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.

The authors concluded by mentioning that in light of the mixed outcomes associated with MIRP, the finding that men of higher socioeconomic status opted for a high-technology alternative despite insufficient data demonstrating superiority over an established gold standard. It may be a reflection of a society and health care system enamored with new technology that increased direct and indirect health care costs but had yet to uniformly realize marketed or potential benefits during early adoption.

The study was published in JAMA, a theme issue on surgical care.