Minimally invasive RP shows some advantages, but certain complications

Minimally invasive procedures for radical prostatectomy, including robotic assistance, 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, according to findings from a recent study.

The study, using Medicare data to compare outcomes in men undergoing minimally invasive radical prostatectomy (MIRP) versus open retropubic radical prostatectomy (RRP), was published in JAMA (2009; 302:1557-64).

"The widespread direct-to-consumer advertising and marketed benefits of MIRP in the United States may promote publication bias against studies that detail challenges and suboptimal outcomes early in the MIRP learning curve," the authors, led by Jim C. Hu, MD, MPH, of Brigham and Women’s Hospital, Boston, wrote. "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."

Dr. Hu and colleagues assessed the outcomes for men with prostate cancer who underwent MIRP (1,938 men) versus RRP (6,899 men) using U.S. Surveillance, Epidemiology, and End Results Medicare-linked data. During the study period, the use of MIRP increased almost fivefold, from 9.2% in 2003 to 43.2% in 2006 and 2007.

After analyses, the researchers found that men undergoing MIRP, compared with those undergoing RRP, experienced shorter hospital length of stay, were less likely to receive transfusions, and were at lower risk of postoperative respiratory complications and miscellaneous surgical complications.

"However, men undergoing MIRP versus RRP experienced more genitourinary complications and were more often diagnosed as having incontinence and erectile dysfunction," the authors wrote. "The need for additional cancer therapies was similar by surgical approach."

The team also found that greater receipt of MIRP versus RRP was associated with living in areas of higher socioeconomic status based on education and income.