MedWire News - Prostate Cancer - Robot-assisted prostate cancer surgery could reduce complications

Prostate Cancer

Robot-assisted prostate cancer surgery could reduce complications

By Sarah Guy

18 December 2009

Urology 2009; Advance online publication

MedWire News: Men treated with robot-assisted radical prostatectomy (RARP) for localized prostate cancer have fewer surgical complications than men treated with open retropubic radical prostatectomy (RRP), research findings show.

Fewer patients treated with RARP in the study required blood transfusions or experienced infectious complications or bladder neck contractures compared with those treated with RRP.

“Radical prostatectomy is associated with specific complications that can affect outcome results in patients,” explain Stefan Carlsson, from the Karolinska Hospital in Stockholm, Sweden, and colleagues.

“The incidence of Clavien IIIb–V complications was significantly lower in the RARP (3.7%) group compared with the RRP group (12.9%),” they report in the journal Urology.

The researchers assessed surgery-related complications in 1253 RARP and 485 RRP patients treated at their institution. Complications included surgical reintervention, blood transfusions, wound infections, and bladder neck contractures. The median follow-up time was 30 months in the RRP cohort and 19 months in the RRP cohort.

In all, 32.8% of the RRP group and 15.7% of the RARP group experienced some form of surgery-related complication.

Within 30 days of treatment, 23.0% of RRP patients needed blood transfusions compared with just 4.6% of RARP patients. The researchers believe this could be partially as a result of “loss of refinement in the technique of vascular control during RRP.”

In all, 2.8% of RRP patients and 1.9% of RARP patients required surgical intervention, with intra-abdominal bleeding being the most common reason for re-intervention.

The most common late postoperative complications were bladder neck contractures, experienced by 4.5% of RRP patients compared with 0.2% of RARP patients. This difference equates to a 20 times higher risk for bladder neck contracture after RRP compared with RARP.

There was a higher incidence of wound infection in the RRP group compared with the RARP group, at 5.9% of patients compared with 0.4%, respectively, giving a relative risk for infection of 12.5 for patients undergoing RRP.

The researchers believe this particular finding is of “great interest” in view of the “increasing antimicrobial resistance and urge for reduced antibiotic use worldwide.”

Carlsson et al conclude: “Our results show that RARP is a viable treatment option for patients with clinically localized prostate cancer and is associated with a low complication rate.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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Comments

At 00:12 on 30/12/2009 Anthony Doerr wrote

This study is clearly flawed. A 23% transfusion rate for open surgery is a joke. I have been performing open radical prostate surgery for the last 10 years and have required transfusion only one time. I have not had a single case of bladder neck contracture with the exception of a patient that traveled for robotic surgery elsewhere returned to later develop contracture. My hospital stay is 24-48 hours. You must also weight the cost of this new technology. When it comes to surgery and complications, it always comes down to the skill of the surgeon be it open or robotic surgery. Clearly the open arm of this study was not performed by a technical surgeon.

urologist, Missoula Urology

At 03:12 on 22/12/2009 Rabbi Ed Weinsberg, Ed.D., D.D. wrote

As you reported with the Swedish study, the lower rate of RARP bladder infection or lower post-op surgical complications are to be expected.

I'm glad this new scientific research validates the intuitive sense I've had from the get-go 2 1/2 years ago as a RALP PCa survivor and healthcare educator.

The precision and magnfication of robotic surgery, using the da Vinci device, are without parallel. I can vouch for that given my own robotic surgery 2 1/2 years ago, and extensive research when writing Conquer Prostate Cancer; How Medicine, Faith, Love and Sex Can Renew Your Life.

I hope further studies will confirm the research results you have cited.What's truly astounding is that RALP patients in your study had half the post-surgical risk than RRP (open surgery) [approx. 30% vs 15%).

This study is a welcome addition to the treatment option literature.

author of Conquer Prsotaet Cancer, Health Succes Media,