A study published in the medical journal European Urology reveals that robot-assisted surgery to treat prostate cancer is more common and significantly more successful in the United States than radical “open” surgery.

The study, conducted by researchers at Henry Ford Hospital’s Vattikuti Urology Institute (VUI), is the first to compare results of robot-assisted radical prostatectomy (RARP) to open radical prostatectomy (ORP) in a nationwide population sample.

Based on a representative 20% sample of the United States, the team found that:

  • Between October 2008 and December 2009, 19,278 patients underwent RARP or ORP in 647 medical institutions.
  • Of the 19,278 patients, 7,389 underwent ORP and 11,889 underwent RARP.
  • RARPs were more likely to be performed at teaching institutions in urban locations and at high-volume hospital’s.
  • ORP patients were more likely than RARP patients to need a blood transfusion, suffer complications during or after surgery, including respiratory, cardiac, and vascular problems, and be hospitalized longer.

In ORP, the surgeon makes a long incision into the lower abdomen in order to remove the entire diseased prostate gland, as well as some of the tissue around it in the hope of preventing the cancer from metastasizing.

In RARP, the surgeon makes tiny incisions using minimally invasive laparoscopic surgery. Henry Ford Hospital pioneered the use of robots to help surgeons in this delicate procedure.

This study confirms findings from prior investigations that RARP is currently the most common method for treating localized prostate cancer in the United States.

In the U.S., prostate cancer is the second leading cause of cancer death in men and the most prevalent “solid organ” malignancy. Radical prostatectomy became the standard treatment after studies demonstrated it improved survival rates.

Quoc-Dien Trinh, M.D., a fellow at VUI and lead author of the study said that in the past 10 years:

“We’ve seen a significant trend toward the use of minimally invasive approaches to RP for the treatment of prostate cancer, particularly in the U.S.

While this evolution has been controversial, there have been few comparative studies. Most of those looked only at single institutions or single surgeons, and they were of poor evidentiary quality.”

The researchers found that RARP produced superior results in almost every outcome they examined, including complications during and after surgery, length of hospitalization, and the amount of necessary blood transfusions.

Mani Menon, M.D., director of Henry Ford’s Vattikuti Urology Institute, explained that 98% of patients at Henry Ford were discharged from the hospital within 24 hours of the procedure and that major complications are under 2%.

Henry Ford conducted the majority of the original work on robotic surgery for prostate cancer.

The researchers used the Nationwide Inpatient Sample (NIS) in order to select study participants. The NIS is maintained by the Agency for Healthcare Research and Quality under the U.S. Department of Health and Human Services.

In another study, urologists and epidemiologists at Henry Ford found that RARP is safe over the long term, and that less than 10% of patients experienced complications. In addition, another Henry Ford study found that almost 87% of patients who underwent RARP had no recurrence of the disease after five years.

A Henry Ford-led international study conducted in September 2011 also found that individuals with prostate cancer get better results at teaching hospitals when undergoing radical prostatectomy than at non-academic medical institutions.

Although the study did not examine the differences in patient access to robotic surgery, the researchers found considerable differences between RARP and ORP patients:

  • More patients were white
  • The surgery was more likely to be performed at urban academic center
  • They had fewer disorders or additional disease.

Dr. Trinh, said:

“This is significant not only because better surgical outcomes are expected at academic centers, but other recent data show that patients without private insurance – those covered by Medicare or Medicaid, or self-paid – are more likely to have complications during and after surgery, and need much more time in the hospital.”

The study received funding from the Vattikuti Urology Institute at Henry Ford Hospital.

Written By Grace Rattue