Prostatectomy patients ‘should be spared bowel preparation’
medwireNews: Japanese research shows that patients with T1 or T2 prostate cancer who do not undergo mechanical bowel preparation prior to laparoscopic prostatectomy fair no worse than patients who do.
Authors Toru Sugihara (University of Tokyo) and colleagues say that the results "support that [mechanical bowel preparation] can be omitted prior to laparoscopic radical prostatectomy for T1-T2 prostate cancer."
The study, published in BJU International, compared the outcomes of 154 patients who did not undergo mechanical bowel preparation before surgery and 580 patients who did.
After adjusting for confounders, mechanical bowel preparation had no significant impact on the overall complication rate (6.5 vs 6.9%), median operation time (222 vs 250 min), median postoperative length of stay (11 vs 10 days), or total costs (US$ 18,941 [€ 14,520] vs US$ 19,015 [€ 14,575]).
The authors explain that since the late 1800s, mechanical bowel preparation has become a "surgical dogma" in abdominal and pelvic surgeries, despite multiple randomized trials disputing its efficacy in colorectal surgery. Indeed, they note that in their study, 79% of patients received mechanical bowel preparation, indicating it is common practice in Japanese hospitals.
Some commentators have also raised concerns that the technique could actually increase the risk for infection as liquid residue in the bowel may be more likely to result in peritoneal spillage than solid bowel contents, and a previous study found no evidence that the procedure reduced the number of fecal organisms in the bowel contents.
Additionally, mechanical bowel preparation is generally an unpleasant, and even distressing, experience for patients, and could induce adverse effects such as patient discomfort - a concern in elderly or already dehydrated patients.
"In addition to these controversial aspects of [mechanical bowel preparation], our study offers new evidence to reinforce the view that [mechanical bowel preparation] can be omitted prior to laparoscopic radical prostatectomy," the authors conclude.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter