Comparative effectiveness of prostate cancer surgical treatments: A population based analysis of postoperative outcomes Journal Article

   

Authors:	Lowrance, W. T.; Elkin, E. B.; Jacks, L. M.; Yee, D. S.; Jang, T. L.; Laudone, V. P.; Guillonneau, B. D.; Scardino, P. T.; Eastham, J. A.
Article Title:	Comparative effectiveness of prostate cancer surgical treatments: A population based analysis of postoperative outcomes
Abstract:	Purpose: Enthusiasm for laparoscopic surgical approaches to prostate cancer treatment has grown despite limited evidence of improved outcomes compared with open radical prostatectomy. We compared laparoscopic prostatectomy with or without robotic assistance vs open radical prostatectomy in terms of postoperative outcomes and subsequent cancer directed therapy. Materials and Methods: Using a population based cancer registry linked with Medicare claims we identified men 66 years old or older with localized prostate cancer who underwent radical prostatectomy from 2003 to 2005. Outcome measures were general medical/surgical complications and mortality within 90 days after surgery, genitourinary/bowel complications within 365 days, radiation therapy and/or androgen deprivation therapy within 365 days and length of hospital stay. Results: Of the 5,923 men 18% underwent laparoscopic radical prostatectomy. Adjusting for patient and tumor characteristics, there were no differences in the rate of general medical/surgical complications (OR 0.93 95% CI 0.77-1.14) or genitourinary/bowel complications (OR 0.96 95% CI. 0.76-1.22), or in postoperative radiation and/or androgen deprivation (OR 0.80 95% CI 0.60-1.08). Laparoscopic prostatectomy was associated with a 35% shorter hospital stay (p <0.0001) and a lower bladder neck/urethral obstruction rate (OR 0.74, 95% CI 0.58-0.94). In laparoscopic cases surgeon volume was inversely associated with hospital stay and the odds of any genitourinary/bowel complication. Conclusions: Laparoscopic prostatectomy and open radical prostatectomy have similar rates of postoperative morbidity and additional treatment. Men considering prostate cancer surgery should understand the expected benefits and risks of each technique to facilitate decision making and set realistic expectations.
Keywords:	laparoscopy; morbidity; prostatic neoplasms; economics; prostate; prostatectomy; experience; minimally invasive; laparoscopic radical prostatectomy; surgical procedures,
Journal Title:	Journal of Urology
Volume:	183
Issue:	4
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2010-04-01
Start Page:	1366
End Page:	1372
Language:	English
ACCESSION:	ISI:000275968200033
DOI:	10.1016/j.juro.2009.12.021
PROVIDER:	wos
PMCID:	PMC2866516
PUBMED:	20188381
Notes:	--- - Article - "Source: Wos"