A new study published in the October 14 issue of the Journal of the American Medical Assn (JAMA) suggests that less invasive surgery for prostate cancer may mean a higher risk of lasting incontinence and impotence when compared with traditional surgery. Advantages of this type of prostate surgery has been fewer hospital days, and a quicker recovery with less chance for infections or other complications.
Although robotic surgery has been increasingly the surgery of choice by prostate cancer patients there have not previously been comparison studies on the outcomes of patients having traditional and minimal invasive surgery.
In the current study the researchers analyzed Medicare data for almost 9,000 prostate cancer patients who had surgical treatment between 2003 and 2007. Of those, 1,938 patients had minimal invasive surgery and 6,899 had traditional surgery. It is unknown how many of the minimal invasive surgery patients had robotic surgery. The patients having keyhole surgery left the hospital a day earlier than the standard surgery patients (2 instead of 3 days on average) and had lower rates of blood transfusions, breathing problems, and internal scarring. But they were more likely to report genital and urinary function complications than the standard surgery group. About 5% of the minimal invasive surgery group as compared to about 2% of the standard surgery group reported these complications. And after 18 months they had more incontinence and erectile dysfunction.
The researchers also found that minimal invasive surgery was more popular with more affluent and highly educated men. This group may tend to seek out care for complications more than the less affluent and thus, skew the findings. In addition, it is believed that the skill of the surgeon may be a factor in the differences found because minimal invasive surgery is relatively new and not all surgeons have had extensive practice in this procedure.
The listeners of the Holistic Health Show will remember Dr David Samadi, Chief of Minimal Invasive and Robotic Surgery at Mt Sinai in New York spoke to this in his interview and said the skill of the physician makes a difference in the outcomes experienced by patients. Dr Samadi who has performed hundreds of the procedures reported he was having about 95% success rate among his patients regarding continence and sexual function following surgery. However, he said these results could vary with the experience of the surgeon.
