Minimally invasive radical prostatectomy (MIRP), which encompasses laparoscopic and robot-assisted procedures, holds no advantage over open radical prostatectomy in terms of complication rates.
Hamburg, Germany-Minimally invasive radical prostatectomy (MIRP), which encompasses laparoscopic and robot-assisted procedures, holds no advantage over open radical prostatectomy in terms of complication rates, says a group of international researchers.
The finding comes from several studies based on data from the U.S. Nationwide Inpatient Sample (NIS). Among the other findings from the studies:
Jan Schmitges, MD, a research fellow in the Health Outcomes Unit of the Martini-Clinic, Hamburg, Germany, told Urology Times that the authors chose the NIS because of its size and the way the data were organized. The database presented the opportunity to answer a number of questions about prostate procedures. He said published studies using population-based data were not uniform in finding or proving benefits for MIRP over the open technique in terms of outcomes or perioperative complications.
"We corroborated many of the findings of the earlier studies," added Dr. Schmitges, who worked on the study with Pierre I. Karakiewicz, MD, of the University of Montreal, and multiple co-authors.
The authors found that blood transfusions were substantially lower in MIRP compared to open procedures (odds ratio [95% CI] 0.39 [0.27–0.55], p<001); miscellaneous medical complications were higher with MIRP (OR [95%CI] 1.30 [1.02-1.65], p=.04); there was a greater risk of postoperative genitourinary complications with MIRP (OR [95% CI] 1.47 [1.09–2.00], p=.01); and length of stay (≥ 2 days) was significantly shorter with MIRP (OR [95% CI] 0.70 [0.54–0.92], p=.01).
"There were no real surprises, but we also did a temporal trend analysis of complications associated with minimally invasive procedures and found that there was a substantial decline in all complications with both laparoscopic and robotic procedures," said Dr. Schmitges.
The authors divided the 4,387 MIRP cases in the study into two time periods, 2001 to 2005 and 2006 to 2007. They found significant declines in overall intra-operative complications (OR [95% CI] 0.41 [0.23–0.72], p=.002), nerve and/or vessel injury (OR [95% CI] 0.41 [0.22–0.75], p=.004), genitourinary complications (OR [95% CI] 0.54 [0.32–0.92 ], p=.02), and length of stay ≥2 days (OR [95% CI] 0.34 [0.02–0.58], p<.001).
"This sort of supports the 'practice makes perfect' hypothesis. Perhaps in 5 or 10 years, minimally invasive procedures will have an advantage over open procedures," said Dr. Schmitges.
Racial disparities continue
In a separate study, the NIS data also showed that while racial disparities continue to exist in terms of MIRP utilization, progress is being made in this area (Cancer 2012; 118:1894–1900). The odds ratio showing that an African-American would utilize MIRP in the period 2001 to 2005 was 0.82 (95% CI [0.72–0.93]). This odds ratio improved to 0.81 (95% CI [0.69–0.95], p=.009) in the 2006–2007 period.
In addition, another study using the NIS data found that a significant majority (72.3%) of patients aged 75 years and older were treated at low- or intermediate-volume hospitals. This is troubling, say the authors, because the low- to intermediate-volume hospitals are associated with higher complication rates and the elderly are a class of patient with less tolerance for complications.