Which Prostate Surgery Is Better?

By Jane Farrell

Robotic surgery, the primary choice for removing cancerous prostate glands, is as safe as open surgery for Medicare patients over 65, according to a new survey.

The findings came in a survey that included analysis by researchers from Henry Ford Hospital. The hospital is a pioneer in robot-assisted radical prostatectomy (RARP), a minimally invasive procedure.

“Although studies comparing the two techniques were done early in the robotic era for this surgery, RARP boomed in more recent years, overtaking open surgery,” says study co-author Jesse D. Sammon, D.O., a researcher at Henry Ford’s Vattikuti Urology Institute and co-author of the study. “Those early studies may no longer apply to contemporary patients, so we chose to compare the two procedures during the latter part of the last decade, after RARP became widely accepted.”

Researchers presented the findings at the annual meeting of the American Urological Association.

As of 2009, more than 60 percent of all radical prostatectomies in the U.S. were done robotically.

The researchers analyzed the results of 5,915 prostate cancer patients between 65 and 80 who were Medicare patients and underwent either procedure between October 2008 and December 2009.
Investigators looked at the results between the two groups for post-operative complications, blood transfusions, readmission, additional cancer treatments and costs of care within the first year after surgery.

They findings were mixed. The researchers found that patients in the different surgical groups had similar risks of complications after 30 days, but RARP patients had fewer complications at 90 days. However, the RARP patients had higher risks of various medical complications. The odds of RARP patients getting a blood transfusion were four times lower. Costs of care in the first year after surgery were higher for RARP patients.

“Although studies in younger patients showed that RARP had an advantage over open surgery in terms of outcomes,” Dr. Sammon explains, “our new study of Medicare patients over age 65 showed that while it is safe, the robot-assisted procedure was not safer than open surgery.”

“And while RARP offers significantly lower risk of blood transfusions and shorter hospital stays, these advantages were balanced by a 10% increase in charges relative to open surgery. This study underscores the importance of surgical experience as well as surgical approach in elderly patients”.