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Utilization and Outcomes of Minimally Invasive Radical Prostatectomy

Jim C. Hu, Qin Wang, Chris L. Pashos, Stuart R. Lipsitz, Nancy L. Keating

From the Division of Urologic Surgery; Center for Surgery and Public Health; Division of General Internal Medicine, Brigham and Women's Hospital; Department of Health Care Policy, Harvard Medical School, Boston, MA; and the Abt Associate Clinical Trials, Bethesda, MD

Corresponding author: Jim C. Hu, MD, MPH, Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA 02115; e-mail: jhu2{at}partners.org

Purpose: Demand for minimally invasive radical prostatectomy (MIRP) to treat prostate cancer is increasing; however, outcomes remain unclear. We assessed utilization, complications, lengths of stay, and salvage therapy rates for MIRP versus open radical prostatectomy assessed whether MIRP surgeon volume is associated with better outcomes.

Methods: We identified 2,702 men undergoing MIRP and open radical prostatectomy during 2003 to 2005 from a national 5% sample of Medicare beneficiaries. We assessed the association between surgical approach and outcomes, adjusting for surgeon volume, age, race, comorbidity, and geographic region.

Results: MIRP utilization increased from 12.2% in 2003 to 31.4% in 2005. Men undergoing MIRP versus open radical prostatectomy had fewer perioperative complications (29.8% v 36.4%; P = .002) and shorter lengths of stay (1.4 v 4.4 days; P < .001); however, they were more likely to receive salvage therapy (27.8% v 9.1%, P < .001). In adjusted analyses, MIRP versus open radical prostatectomy was associated with fewer perioperative complications (odds ratio [OR], 0.73; 95% CI, 0.60 to 0.90), shorter lengths of stay (parameter estimate, –2.99; 95% CI, –3.45 to –2.53) but more anastomotic strictures (OR, 1.40; 95% CI, 1.04 to 1.87) and higher rates of salvage therapy (OR, 3.67; 95% CI, 2.81 to 4.81). Patients of high-volume MIRP experienced fewer anastomotic strictures (OR, 0.93; 95% CI, 0.87 to 0.99) and less salvage therapy (OR, 0.92; 95% CI, 0.88 to 0.98).

Conclusion: Men undergoing MIRP versus open radical prostatectomy have lower risk for perioperative complications and shorter lengths of stay, but are at higher risk for salvage therapy and anastomotic strictures. However, risk for these unfavorable outcomes decreases with increasing MIRP surgical volume.

Supported by a Lance Armstrong Young Investigator Award and a Dana Farber/Harvard Cancer Center Career Development Award (J.C.H.); and by an intramural grant by the Brigham and Women's Center for Surgery and Public Health.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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• Radical Prostatectomy by Open or Laparoscopic/Robotic Techniques: An Issue of Surgical Device or Surgical Expertise?
  Michael L. Blute
  JCO 2008 26: 2248-2249 [Full Text]

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				M. L. Blute Radical Prostatectomy by Open or Laparoscopic/Robotic Techniques: An Issue of Surgical Device or Surgical Expertise? J. Clin. Oncol., May 10, 2008; 26(14): 2248 - 2249. [Full Text] [PDF]