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13 May 2008
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MIRP risk-benefit ratio determined
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MedWire News: The pros and cons of minimally invasive radical prostatectomy (MIRP) for prostate cancer compared with open surgery have been determined by US researchers.
MIRP offers a lower risk of peri-operative complications and a shorter hospital stay than standard RP, but the investigators found men who underwent MIRP were more likely to develop anastomotic strictures and require salvage treatment.
However, the risk for poor outcomes was significantly reduced with increasing surgeon experience, the team reports in the Journal of Clinical Oncology.
"Given the rapid adoption, increased patient demand, steep learning curves, and low RP volumes for the majority of practicing urologists, additional research is needed to delineate long-term outcomes such as urinary and sexual function to guide men considering MIRP," Jim Hu (Brigham and Women's Hospital, Boston, Massachusetts) and colleagues write.
"These studies may characterize minimally invasive surgeon experience thresholds and redefine current certification practices for obtaining MIRP privileges to optimize outcomes."
Examining medical records for 2702 Medicare beneficiaries who underwent MIRP or open RP between 2003 and 2005, the team found that MIRP became increasingly more common, from 12.2% of procedures in 2003 to 31.4% in 2005.
Men who underwent MIRP were less likely to experience respiratory, wound or bleeding, genitourinary, and other medical complications than those who underwent open RP (29.8% vs 36.4%) and had a shorter hospital stay (1.4 vs 4.4 days).
After adjusting for surgeon volume, age, race, comorbidity, and geographic region, MIRP was associated with an increase in anastomotic strictures (odds ratio [OR]=1.40) and an increase in salvage therapy use (OR=3.67).
However, the risk for both anastomotic strictures (OR=0.93) and salvage therapy (OR=0.92) were lower in patients whose surgeon had performed a high volume (>20) of MIRPs than in men whose surgeon had performed fewer MIRPs.
"MIRP diffused rapidly over the study period, and is associated with a lower risk of peri-operative complications and shorter lengths of stay, but an increased risk for anastomotic strictures and early cancer recurrence compared with open RP," Hu et al summarize.
"Nevertheless, among men who underwent MIRP, higher minimally invasive surgeon volumes were associated with a lower risk of anastomotic strictures and salvage therapy, suggesting better cancer control," they add.
J Clin Oncol 2008; 26: 2278-2284
http://jco.ascopubs.org/cgi/content/abstract/26/14/2278
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