Minimally invasive prostatectomy in young men has fewer complications than standard prostatectomy
Men between ages 18 and 64 who underwent surgery for localized prostate cancer between 2003 and 2007 were more likely to undergo minimally invasive radical prostatectomy (MIRP) than traditional retropubic radical prostatectomy (RRP), also known as "open surgery," according to a new study. MIRP involves laparoscopic surgery, either with or without robot assistance, requiring only small incisions. The study also found that MIRP had fewer complications, which appeared to have offset its higher hospitalization costs.
The researchers examined data from the LifeLink Health Plan Claims Database on 10,699 nonelderly men who underwent either MIRP or RRP between 2003 and 2007. They found a sharp increase in the proportion of patients treated with MIRP, increasing from 5.7 percent in 2003 to 50.3 percent in 2007. They looked at the use of MIRP and RRP in younger men, tried to identify factors associated with each type of procedure, and compared outcomes (complication rates, length of hospital stay, hospitalization costs, and total costs within 3 and 6 months of surgery). They found that men who underwent MIRP had a significantly lower rate of complications (23.0 vs. 30.4 percent). However, men who underwent MIRP also had higher mean hospitalization costs—despite shorter mean hospital stays—than those who underwent RRP ($19,998 for a 1.7-day stay vs. $18,424 for a 3.1-day stay). Men with 1 or 2 coexisting illnesses were 12 percent and 73 percent less likely, respectively, to undergo MIRP than men with no coexisting conditions.
Based on their data, the researchers recommend research to explore whether the increased use of MIRP reflects overtreatment of prostate cancer in younger men. The study was funded in part by the Agency for Healthcare Research and Quality (HS18535).
More details are in "Comparative effectiveness, cost, and utilization of radical prostatectomy among young men within managed care insurance plans," by Ya-Chen Tina Shih, Ph.D., John F. Ward, M.D., Curtis A. Pettaway, M.D., and others in the March 2012 Value in Health 15(2), pp. 367-375.
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