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(Ivanhoe Newswire) -- The use of minimally invasive procedures for radical prostatectomy may shorten hospital stays and decrease respiratory and surgical complications, but may also result in the increase of certain long-term complications, such as incontinence and erectile dysfunction, according to a new study.
Between 2001 and 2006, minimally invasive radical prostatectomy (MIRP), in particular with the use of robotic assistance, increased from 1 percent to 40 percent of all radical prostatectomies. This rapid increase occurred despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP) surgery in which an incision is made in the lower abdomen to remove the prostate.
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"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 was quoted as saying.
Dr. Hu and colleagues assessed the outcomes for men with prostate cancer who underwent MIRP versus RRP using U.S. Surveillance, Epidemiology and End Results Medicare linked data. During the study period, the use of MIRP increased almost five-fold, from 9.2 percent in 2003 to 43.2 percent in 2006-2007.
After analyses, the researchers found that men undergoing MIRP experienced shorter hospital length of stay, were less likely to receive transfusions, and were at lower risk of postoperative respiratory 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 need for additional cancer therapies was similar by surgical approach," the authors wrote.
The researchers also found that greater receipt of MIRP was associated with living in areas of higher socioeconomic status based on education and income, and that this may be the result 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, "In light of the mixed outcomes associated with MIRP, our finding that men of higher socioeconomic status opted for a high-technology alternative despite insufficient data demonstrating superiority over an established gold standard 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."
SOURCE: Journal of the American Medical Association (JAMA), October 14, 2009
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