Utilization And Outcomes Of Minimally Invasive Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 13 Jul 2008 - 0:00 PDT

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UroToday.com - In the May 10, 2008 issue of the Journal of Clinical Oncology, Dr. Jim Hu and associates report on minimally invasive radical prostatectomy (MIRP). Using a 5% sampling of Medicare beneficiaries, 2,702 men undergoing MIRP and open RP from 2003-2005 were identified. Variables assessed included perioperative complications, length of hospital stay, anastomotic strictures, and initiation of salvage therapies.

During this 2 year span, MIRP increased from 12.2% to 31.4% of all radical prostatectomies. In contrast, open RP decreased. No racial or geographic variations in utilization were noted. However, men undergoing MIRP were older.

While the authors state that MIRP men are more likely to have comorbid conditions, they in fact tabulate their data incorrectly, and 8.4% of MIRP men had higher comorbidity scores compared to 12.1% in the open group (they tabulate 2.1%, which explains the inaccurate conclusion). The unadjusted overall perioperative complication rate for MIRP was 29.8%, compared to 36.4% for open RP. MIRP had fewer cardiac, respiratory, wound, bleeding, genitourinary and miscellaneous medical complications. Mean length of stay was 3 days shorter for MIRP vs. open RP. The rate of anastomotic stricture however was 3% higher after MIRP vs. open RP.

In adjusted analysis, men undergoing MIRP were less likely to develop perioperative complications and experienced shorter lengths of stay. In the adjusted analysis, MIRP was associated with higher stricture rates and more salvage therapies with 6 months of surgery. Multiple comorbidities and older age were associated with perioperative complications, anastomotic strictures, longer length of hospitalization and a greater likelihood of salvage therapy.

Overall rates of salvage therapy ranged from 40.4% for low volume surgeons, to 32.3% for medium and 18.95 for high volume surgeons.

Hu JC, Wang Q, Pashos CL, Lipsitz SR, Keating NL
J Clin Oncol. 2008 May 10;26(14):2278-84 10.1200/JCO.2007.13.4528

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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