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In a study published on-line within the Journal of Urology, researchers from the Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, examined the postoperative outcomes of both ORP and LRP and found similar rates of success. They advise that guys thinking about prostate cancer surgery ought to understand the expected advantages and risks of each technique to facilitate selection making and set realistic expectations.
Of the 200,000 guys newly diagnosed with prostate cancer each year within the United States, about one-third will undergo surgical treatment. Though open radical prostatectomy (ORP) is regarded as the standard treatment, laparoscopic radical prostatectomy (LRP) with or with out robotic assistance is becoming a lot more common.
In a study published on the internet in The Journal of Urology, researchers from the Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, examined the postoperative outcomes of each ORP and LRP and found similar rates of success. They advise that males considering prostate cancer surgery must comprehend the expected rewards and risks of each technique to facilitate choice making and set realistic expectations.
Enthusiasm for LRP, specifically for LRP with robotic assistance, has grown rapidly despite limited evidence of its superiority to ORP. Whilst most studies to date happen to be according to a limited number of patients or from single institutions, the authors with the current study compared ORP and LRP outcomes in a population based cohort of almost 6000 guys 66 years of age or older with clinically localized prostate cancer, controlling for patient and tumor characteristics, and examined the impact of surgeon volume in men treated with LRP.
Dr. Yair Lotan, Department of Urology, University of Texas Southwestern Medical Center, Dallas, comments on the study, “A concern of these authors is the perception amongst patients that the robotic approach to prostatectomy is significantly superior. This perception is often reinforced by advertising from market and physicians. Patients deserve to have a realistic expectation of surgical outcomes, especially considering the multiple other accessible treatment alternatives. Notably the main information that a patient must know is not the prostatectomy approach but surgeon experience. Several studies show that the primary determinant of prostatectomy outcome is surgical volume. Patients ought to be educated on likely outcomes of a procedure according to individual surgeon experience. Unfortunately this data is often harder to obtain than published reports from experts within the field.”
After adjusting for patient and tumor characteristics, there had been no differences in the rate of general medical/surgical complications or genitourinary/bowel complications, or in postoperative radiation and/or androgen deprivation. LRP was connected with a 35% shorter hospital stay and a lower bladder neck/urethral obstruction rate. In laparoscopic cases, the surgeon’s experience with the procedure was inversely associated with hospital stay and also the odds of any genitourinary/bowel complication.
Writing inside the write-up, William T. Lowrance, MD, and colleagues state, “Results suggest that ORP and LRP have similar rates of postoperative mortality and morbidity. Controlling for important patient and tumor characteristics, the only differences favoring LRP had been shorter length of stay and a lower threat of bladder neck or urethral obstruction. All guys taking into consideration radical prostatectomy really should be clearly informed about the differences among the two techniques and similarities in their expected outcomes, and make treatment decisions in collaboration with an experienced surgeon.”
Source: Elsevier