Serious risk for postoperative incontinence and impotence may outweigh the benefits of keyhole minimally invasive, surgery for prostate cancer, a new study suggests. The supposed good from robotics are oversold to a public too willing to believe, said Dr. Jim C. Hu, genito-urinary surgeon at Brigham and Women’s Hospital in Boston, who led the study.
"Given the cost of the procedure and the hype around it, expectations were raised that are too high," said Hu, whose team published the results of the October 14 Journal of the American Medical Association.
Men with prostate-removal surgery, which requires only a small incision and is helped by the robotic technology, please leave the hospital faster than those having an older transaction, the report said. Patients who have suffered the most high-tech surgical spent an average of two days in hospital, rather than the end of three days seen with traditional procedures. They were also less likely to require transfusions of blood or exposed to respiratory complications or surgical, the researchers found.
But the study of over 8800 men, also found a higher incidence of genito-urinary complications, including impotence and incontinence among those that the procedure of the keyhole (4.7 percent) than those who had traditional surgery ( 2.1 per cent).
And yet the popularity of minimally invasive prostatectomy, especially if done with the assistance of robotics continues to grow. It represented more than 40 percent of all prostate surgery in 2006, with effect from 1 percent in 2001, the report said.
That growth was fueled by "widespread direct to consumer advertising," according to the report.
The mini-invasive technique is particularly popular among high-income patients, the research team said. This may be the result of a "successful assistant robot MIRP [Minimally invasive radical prostatectomy] marketing campaign to spread via the Internet, radio and print media channels, which may be frequented by men of high socioeconomic status, has written .
"Patients are demanding," agrees Dr. Stephen J. Freedland, an associate professor of urology and pathology at Duke University Medical Center, which operates a prostate surgery, but not a mini-invasive. "In many cases, if the surgeon is not offered, the patient will not come to you. So you have no choice. You do robotic surgery or no surgery is done."
Men who were diagnosed with prostate cancer usually go directly to the Internet for information, and what you usually find the reports on the benefits of minimally invasive robotic surgery, Freedland said.
"But we are learning more and more that there are all the benefits that were touted," he said. "There are some benefits. But for long-term outcomes, there is no benefit and perhaps some damage."
The numbers of the new study "is very worrying," said Freedland. "We need to find a rate of incontinence, which is 30 percent higher and the rate of erectile dysfunction, which is 40 percent higher, and those are really important."
And the robot technology is not easily dominated by doctors, he said. "The learning curve is 150 to 200 patients, 150 so the sooner you do, you practice on them," said Freedland.
Men who are considering minimally invasive surgery of the prostate should first check carefully the training of surgeons doing the procedure, said Hu.
"You should go online to see how long the process has been made available to [the clinic]," he said. "You should ask about how surgeons have been trained to do so if they have extensive training program or simply a normal course of a day."
Minimally invasive robotic surgery for prostate cancer is at an early stage of development, said Hu, and surgical techniques necessary to preserve function and prevent urological incontinence and impotence are not yet finalized.
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