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| |  Few Differences in Outcomes Between Open and Laparoscopic Prostate Surgery NEW YORK -- February 22, 2010 -- In a study published online today in the Journal of Urology, examined the postoperative outcomes of both radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) and found similar rates of success The authors advise that men considering prostate cancer surgery should understand the expected benefits and risks of each technique to facilitate decision making and set realistic expectations. Enthusiasm for LRP, specifically for LRP with robotic assistance, has grown rapidly despite limited evidence of its superiority to ORP. While most studies to date have been based on a limited number of patients or from single institutions, William T. Lowrance, MD, Memorial Sloan-Kettering Cancer Center, New York, New York, and colleagues compared ORP and LRP outcomes in a population based cohort of almost 6,000 men aged 66 years or older with clinically localised prostate cancer, controlling for patient and tumour characteristics, and examined the impact of surgeon volume in men treated with LRP. “A concern of these authors is the perception among patients that the robotic approach to prostatectomy is significantly superior,” commented Yair Lotan, MD, Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas. “This perception is often reinforced by advertising from industry and physicians. Patients deserve to have a realistic expectation of surgical outcomes, especially considering the multiple other available treatment options. Notably the main information that a patient must know is not the prostatectomy approach but surgeon experience. Several studies show that the primary determinant of prostatectomy outcome is surgical volume. Patients should be educated on likely outcomes of a procedure based on individual surgeon experience. Unfortunately this information is often harder to obtain than published reports from experts in the field.” After adjusting for patient and tumour characteristics, there were no differences in the rate of general medical/surgical complications or genitourinary/bowel complications, or in postoperative radiation and/or androgen deprivation. LRP was associated with a 35% shorter hospital stay and a lower bladder neck/urethral obstruction rate. In laparoscopic cases, the surgeon’s experience with the procedure was inversely associated with hospital stay and the odds of any genitourinary/bowel complication. “Results suggest that ORP and LRP have similar rates of postoperative mortality and morbidity,” the authors wrote. “Controlling for important patient and tumour characteristics, the only differences favouring LRP were shorter length of stay and a lower risk of bladder neck or urethral obstruction. All men considering radical prostatectomy should be clearly informed about the differences between the 2 techniques and similarities in their expected outcomes, and make treatment decisions in collaboration with an experienced surgeon.”
SOURCE: Elsevier Health Sciences
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