Minimally Invasive Prostate Surgery May Have Pros and Cons

Laparoscopic radical prostatectomy, a less invasive surgical procedure that has gained in popularity in recent years, appears to result in shorter hospital stays, fewer blood transfusions, and fewer postoperative respiratory complications than open, retropubic radical prostatectomy, but higher rates of incontinence and erectile dysfunction. These results were published in the Journal of the American Medical Association

Radical prostatectomy refers to the surgical removal of the entire prostate and some surrounding tissue. It is one of the treatment options available to men with early prostate cancer. Prostatectomy may be performed using traditional, open surgery, in which the surgeon makes a single, long incision, or through a laparoscopic procedure (sometimes called minimally invasive surgery) in which several small incisions are made. During laparoscopy, the surgeon inserts a small video camera through one of the incisions in order to see inside the abdomen. In a variant of laparoscopic surgery known as robotic-assisted laparoscopic surgery, the surgeon sits at a console near the operating table and performs the surgery by controlling robotic arms that hold the surgical instruments. 

Although minimally invasive radical prostatectomy (MIRP) has been in use for several years, no randomized studies have directly compared it to open retropubic radical prostatectomy (RPP). 

To explore how type of surgery affects surgical outcomes among men with prostate cancer, researchers analyzed Medicare and cancer registry data for the years 2003 to 2007. Information was available about 1,938 prostate cancer patients who had been treated with MIRP and 6,899 who had been treated with RPP. 

Among men undergoing prostatectomy, use of MIRP increased from 9.2% in 2003 to 43.2% in 2007. 

  • Compared with men treated with RPP, men treated with MIRP were less like to be black or Hispanic and more likely to live in areas with high education levels and high incomes.
  • Median hospital stay was 2 days among men treated with MIRP and 3 days among men treated with RPP.
  • 2.7% of men treated with MIRP received a blood transfusion, compared with 20.8% of men treated with RPP.
  • Postoperative respiratory complications developed in 4.3% of men treated with MIRP and 6.6% of men treated with RPP.
  • Anastomotic strictures (internal scarring) occurred in 5.8% of men treated with MRIP and 14% of men treated with RPP.
  • Genitourinary complications developed in 4.7% of men treated with MIRP and 2.1% of men treated with RPP.
  • The rate of diagnosed erectile dysfunction (per 100 person-years; the equivalent of 100 people followed for a year) was 26.8 among men treated with MIRP and 19.2 among men treated with RPP.
  • The rate of diagnosed incontinence (again, per 100 person-years) was 15.9 among men treated with MIRP and 12.2 among men treated with RPP. 

These results suggest that MIRP may shorten hospital stays and decrease the risk of respiratory complications, blood transfusions, and strictures, but may increase the risk of genitourinary complications, erectile dysfunction, and incontinence. 

Men who are considering radical prostatectomy may wish to talk with their doctor about the risks and benefits of each type of surgical procedure. 

Reference: Hu JC, Gu X, Lipsitz SR, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. Journal of the American Medical Association 2009;302:1557-1564.

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