A new study suggests less invasive a prostate cancer treatment that often uses robots to conduct surgery may mean a higher risk for incontinence and impotence compared to traditional surgery.
The study, published in JAMA, the Journal of the American Medical Association, finds that while "minimally invasive" prostate surgeries shorten hospital stays and decrease respiratory and surgical complications, they may also result in more complications later, including erectile dysfunction and bladder control issues.
Laparoscopic, or keyhole, surgery is increasingly chosen by men having a cancerous prostate removed. Often, it involves the highly-marketed da Vinci robotics system.
In Canada, there are still just a handful of hospitals that have adopted the robotic equipment needed for the surgery. In the U.S., meanwhile, minimally invasive radical prostatectomy (MIRP), in particular with the use of robotic assistance, is used in more than to 40 per cent of all prostate removal surgeries.
While robotic surgery popularity has been growing, there have been some who have noted there have few studies comparing its outcomes with those of standard surgery.
For this study, researchers led by Dr. Jim C. Hu of Brigham and Women's Hospital in Boston, analyzed data for nearly 9,000 prostate cancer patients who had surgical treatment from 2003 to 2007. Of those, 1,938 patients had minimally invasive surgery and 6,899 patients had standard surgery. The data did not indicate how many of the less invasive cases involved robotics.
In minimally invasive surgery, small incisions are made and the doctor uses a tiny camera and instruments, called a laparascope, for the operation.
When robotics are used, the doctor sits at a console and manipulates similar instruments attached to robotic arms that work on the patient.
In traditional, open prostatectomy, an incision is made in the lower abdomen to remove the
The patients who had keyhole surgery left the hospital in two days, rather than three, on average. They also had lower rates of blood transfusions, breathing problems and internal scarring.
The two techniques were about the same for controlling the cancer.
But the men who had keyhole surgery were more likely to report complications in the first 30 days after surgery involving genital and urinary function.
About five per cent of the minimally invasive surgery patients vs. about two per cent of the standard surgery patients had these complications. After 18 months, they also had more incontinence and erectile dysfunction.
Lu's team noted that men who got the minimally invasive surgery were far more likely to live in areas with higher education levels and affluence. The fact that men from such areas preferred the higher technology and more expensive treatment --"despite insufficient data demonstrating superiority" -- may reflect a health care system "enamored with new technology," Hu and colleagues wrote.
Dr. Herbert Lepor of New York University's Langone Medical Center, who was not involved in the study, analyzed several studies on robotic-assisted prostate surgery in a paper published this year in Reviews in Urology. He told Reuters that so far, the evidence does not suggest the robotic procedure is superior to open surgery.
But Ryan Rhodes, marketing director for Intuitive Surgical, which makes the da Vinci system, disputed the findings.
"There have been over 800 papers published in peer-reviewed journals talking about the outcomes of radical prostatectomy. The majority of these were favorable," he told Reuters.
