Robotic vs Open prostate surgery

[Guest guest]

Robotic surgery (RALP, Da Vinci) is becoming more popular than conventional open surgery for prostate cancer.

Are the outccmes of robotic surgery better with respect to cancer control and side effects than open surgery?

Increasingly, studies are showing that on average the only advantage to the patient of robotic surgery is slightly faster recovery from the operation itself. Whether or not there is a significant advantage of robotic surgery to the finances of the hospital or doctor is an entirely different topic...

Of course, there is always the exception-- treatment results from very experienced 'artists' are always better than the average, especially for robotic surgery which has been demonstrated to have a long learning curve.

The Best to You and Yours!

Jon in Nevada

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Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men.J Clin Oncol. 2012 Jan 3. [Epub ahead of print]

Barry MJ, Gallagher PM, Skinner JS, Fowler FJ Jr.

J. Barry, Massachusetts General Hospital; M. Gallagher and Floyd J. Fowler Jr, University of Massachusetts; J. Barry and Floyd J. Fowler Jr, Foundation for Informed Medical Decision Making, Boston, MA; S. Skinner, Dartmouth College and The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH.

PURPOSE Robotic-assisted laparoscopic radical prostatectomy is eclipsing open radical prostatectomy among men with clinically localized prostate cancer. The objective of this study was to compare the risks of problems with continence and sexual function following these procedures among Medicare-age men.

PATIENTS AND METHODS A population-based random sample was drawn from the 20% Medicare claims files for August 1, 2008, through December 31, 2008. Participants had hospital and physician claims for radical prostatectomy and diagnostic codes for prostate cancer and reported undergoing either a robotic or open surgery. They received a mail survey that included self-ratings of problems with continence and sexual function a median of 14 months postoperatively.

Results Completed surveys were obtained from 685 (86%) of 797 eligible participants, and 406 and 220 patients reported having had robotic or open surgery, respectively. Overall, 189 (31.1%; 95% CI, 27.5% to 34.8%) of 607 men reported having a moderate or big problem with continence, and 522 (88.0%; 95% CI, 85.4% to 90.6%) of 593 men reported having a moderate or big problem with sexual function. In logistic regression models predicting the log odds of a moderate or big problem with postoperative continence and adjusting for age and educational level, robotic prostatectomy was associated with a nonsignificant trend toward greater problems with continence (odds ratio [OR] 1.41; 95% CI, 0.97 to 2.05). Robotic prostatectomy was not associated with greater problems with sexual function (OR, 0.87; 95% CI, 0.51 to 1.49).

CONCLUSION Risks of problems with continence and sexual function are high after both procedures. Medicare-age men should not expect fewer adverse effects following robotic prostatectomy.

PMID: 22215756

[Guest guest]

All else being equal, i.e. incontinece and ED, I'll take the faster recovery time and minimal pain and discomfort of RALP. I had RALP and found it a breeze. At age 68 the incontinence was gone in about four months and not disconcerting after three. ED is still a work in progress, but there is progress as my second annivesary approaches.

To: PROSTATE ; ProstateCancerSupport <ProstateCancerSupport >; ww Sent: Wednesday, February 1, 2012 1:25 PMSubject: Robotic vs Open prostate surgery

Robotic surgery (RALP, Da Vinci) is becoming more popular than conventional open surgery for prostate cancer.

Are the outccmes of robotic surgery better with respect to cancer control and side effects than open surgery?

Increasingly, studies are showing that on average the only advantage to the patient of robotic surgery is slightly faster recovery from the operation itself. Whether or not there is a significant advantage of robotic surgery to the finances of the hospital or doctor is an entirely different topic...

Of course, there is always the exception-- treatment results from very experienced 'artists' are always better than the average, especially for robotic surgery which has been demonstrated to have a long learning curve.

The Best to You and Yours!

Jon in Nevada

---------------------------------------------

Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men.J Clin Oncol. 2012 Jan 3. [Epub ahead of print]

Barry MJ, Gallagher PM, Skinner JS, Fowler FJ Jr.

J. Barry, Massachusetts General Hospital; M. Gallagher and Floyd J. Fowler Jr, University of Massachusetts; J. Barry and Floyd J. Fowler Jr, Foundation for Informed Medical Decision Making, Boston, MA; S. Skinner, Dartmouth College and The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH.

PURPOSE Robotic-assisted laparoscopic radical prostatectomy is eclipsing open radical prostatectomy among men with clinically localized prostate cancer. The objective of this study was to compare the risks of problems with continence and sexual function following these procedures among Medicare-age men.

PATIENTS AND METHODS A population-based random sample was drawn from the 20% Medicare claims files for August 1, 2008, through December 31, 2008. Participants had hospital and physician claims for radical prostatectomy and diagnostic codes for prostate cancer and reported undergoing either a robotic or open surgery. They received a mail survey that included self-ratings of problems with continence and sexual function a median of 14 months postoperatively.

Results Completed surveys were obtained from 685 (86%) of 797 eligible participants, and 406 and 220 patients reported having had robotic or open surgery, respectively. Overall, 189 (31.1%; 95% CI, 27.5% to 34.8%) of 607 men reported having a moderate or big problem with continence, and 522 (88.0%; 95% CI, 85.4% to 90.6%) of 593 men reported having a moderate or big problem with sexual function. In logistic regression models predicting the log odds of a moderate or big problem with postoperative continence and adjusting for age and educational level, robotic prostatectomy was associated with a nonsignificant trend toward greater problems with continence (odds ratio [OR] 1.41; 95% CI, 0.97 to 2.05). Robotic prostatectomy was not associated with greater problems with sexual function (OR, 0.87; 95% CI, 0.51 to 1.49).

CONCLUSION Risks of problems with continence and sexual function are high after both procedures. Medicare-age men should not expect fewer adverse effects following robotic prostatectomy.

PMID: 22215756