Robotic-Assisted Surgery for Prostate Cancer
The public may believe it's superior to surgery performed solely by humans, but are they correct?
Robotic-assisted laparoscopic radical prostatectomy is heavily advertised and frequently sought after by men with localized prostate cancer. The idea that the sure and steady “hands” of a robot are superior to those of surgeons performing open radical prostatectomies is appealing to many. However, until now, it was unknown how post-procedure problems with urinary continence and sexual function compared.
In a study spear-headed by Michael Barry, MD, of the Massachusetts General Hospital, apopulation-based random sample of hospital and physician Medicare claims for radical prostatectomy and diagnostic codes for prostate cancer and reported undergoing either a robotic or open surgery was obtained. The study period was August 1, 2008 through December 31, 2008, and potential study recipients received a mailed survey that included self-ratings of problems with urinary continence and sexual function a median of 14 months postoperatively.
Completed surveys were obtained from 685 (86%) of 797 eligible participants, and 406 and 220 patients reported having had robotic-assisted or open surgery, respectively. Overall, 189 (31%) of 607 men reported having a “moderate” or “big” problem with urinary continence, and 522 (88%) of 593 men reported having a “moderate” or “big” problem with sexual function. In logistic regression models predicting the log odds of a “moderate” or “big” problem with postoperative continence and adjusting for age and educational level, robotic prostatectomy was associated with a non-significant trend toward greater problems with urinary continence. Robotic-assisted prostatectomy was not associated with greater problems with sexual function. The researchers concluded that risks of problems with continence and sexual function are high after both procedures, and that older men should not expect fewer adverse effects following robotic-assisted prostatectomy.
Barry MJ, Gallagher PM, Skinner JS, Fowler FJ. Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of Medicare-Age Men. Journal of Clinical Oncology. January 3, 2012, epub ahead of print, doi 10.1200/JCO.2011.36.8621