Postoperative outcomes do not differ between open versus laparoscopic prostatectomy
MedWire News: Postoperative rates of mortality, morbidity, and requirement for additional treatment are similar between patients who undergo open radical prostatectomy (ORP) and laparoscopic prostatectomy (LRP), report US researchers.
The laparoscopic approach has become increasingly popular, with a third of US surgical prostate cancer patients choosing the procedure each year despite limited evidence of its superiority, notes the research team.
Lead author William Lowrence (Memorial Sloan-Kettering Cancer Center, New York) told MedWire News: “Men deciding which surgical approach to pursue should be aware of the similar outcomes and have realistic expectations.”
He added: “Patients should ask their physician detailed questions about expected risks and outcomes of various prostate cancer treatment alternatives. It is important they find an experienced, well-trained surgeon who provides them with realistic postoperative expectations.”
The team identified 5923 men with clinical stage T1 or T2 prostate cancer, 82% of whom underwent ORP and 18% LRP.
The researchers assessed postoperative rates of general medical or surgical complications and mortality within 90 days of surgery, genitourinary or bowel complications within 1 year of surgery, the need for radiation and/or androgen deprivation therapy within 1 year of surgery, and length of hospital stay.
The results, published today in The Journal of Urology, show that the 90-day mortality rate was under 0.5% in both treatment groups, and rates of general or surgical complications (such as cardiac, vascular, and respiratory events) were also similar, at 21% after LRP, and 24% after ORP.
Approximately 9% and 12% of LRP and ORP patients received additional therapy, which after adjusted analysis, was not significantly associated with either procedure.
Similarly, genitourinary or bowel complications were experienced by comparable numbers of LRP and ORP patients after surgery. Specifically, 29% of patients in both groups experienced bladder neck or urethral obstruction, which, after adjustment for patient and tumor characteristics, translated as a 26% lower risk for LRP patients compared with ORP patients.
“There was no evidence of a difference in urinary complications between the laparoscopic and open groups,” said Lowrence.
Finally, LRP patients’ hospital stays were on average 35% shorter than those of ORP patients, with mean hospital stays of 2 days and 3 days, respectively. Surgeon volume (ranging between 1–68 procedures per year) was also associated with a shorter stay in hospital.
Lowrence and team are continuing their research in the area with a focus on long-term urinary function, erectile function, and quality of life after LRP versus ORP.
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By Sarah Guy