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January 10, 2012 • Volume 9 / Number 1
Older men who have their prostates removed to treat cancer have a high risk of developing incontinence and sexual problems within a year, regardless of whether their surgeons use robotic technology in the operating room, a new survey suggests. The results 1 appeared online January 3 in the Journal of Clinical Oncology.
More than four out of five prostatectomies are done with the use of robotic technology to remove the organ laparoscopically. Some researchers have noted that the widespread adoption of this technology 2 has occurred in the absence of evidence demonstrating that the robotic approach has clear benefits for patients over traditional surgery.
To explore this question further, Dr. Michael Barry of Massachusetts General Hospital and his colleagues sent surveys to a random sample of 800 men, drawn from Medicare claims files, who had undergone radical prostatectomy for prostate cancer. They received responses from 685 men; nearly twice as many respondents reported having robotic-assisted surgery as having a traditional open radical prostatectomy.
Both groups of patients reported high rates of incontinence and sexual dysfunction, indicating that the robotic technology did not appear to reduce these complications.
“The very rapid dissemination of robotic surgeries for radical prostatectomy seems to have come with an assumption that there may be fewer side effects because of the increased precision offered by the technology,” said Dr. Barry. But the new results, which are consistent with those of an earlier study 3, challenge that assumption. In fact, the study showed a slight increase in incontinence among men who had robotic surgery, although the difference was not statistically significant.
One limitation of the study was that the authors did not have baseline information about continence and sexual function for the men prior to the prostatectomy. Prospective studies and studies of younger men will be needed to assess the risks and benefits, as well as the cost effectiveness, of robotic surgery for prostate cancer compared with traditional surgery, the authors noted.
Despite the study’s limitations, the results are “sobering,” given the high rates of problems associated with both procedures, the authors of an accompanying editorial 4 concluded. They noted that the outcomes for any type of procedure “are based not only on the technology but also on the skill and experience of the provider and the hospital system.”
Dr. Barry agreed. “Each man should know that the type of surgery he chooses is not as important as the experience that his surgeon has with that particular procedure,” he said. “And just because the surgery is robotic does not mean that it is safer or better than another technique.”
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