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• W2007488738 abstract "No AccessJournal of UrologyAdult Urology1 Nov 2008Patterns of Care for Radical Prostatectomy in the United States From 2003 to 2005 Jim C. Hu, Nathanael D. Hevelone, Marcos D. Ferreira, Stuart R. Lipsitz, Toni K. Choueiri, Martin G. Sanda, and Craig C. Earle Jim C. HuJim C. Hu Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts More articles by this author , Nathanael D. HeveloneNathanael D. Hevelone Center for Outcomes and Policy Research, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts More articles by this author , Marcos D. FerreiraMarcos D. Ferreira Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author , Stuart R. LipsitzStuart R. Lipsitz Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author , Toni K. ChoueiriToni K. Choueiri Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts More articles by this author , Martin G. SandaMartin G. Sanda Division of Urologic Surgery, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author , and Craig C. EarleCraig C. Earle Center for Outcomes and Policy Research, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.07.054AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The demand for minimally invasive radical prostatectomy is increasing, although population based outcomes remain unclear. We assessed use and outcomes in American men undergoing radical prostatectomy. Materials and Methods: We identified 14,727 men undergoing minimally invasive, perineal and retropubic radical prostatectomy during 2003 to 2005 using nationally representative, employer based administrative data. We assessed the association between surgical approach and outcomes, adjusting for age, race, comorbidity and geographic region. Results: Minimally invasive radical prostatectomy use increased from 5.4% to 24.4%, while conversion to open surgery decreased from 28.6% to 4.5% in the 3-year study. Men undergoing minimally invasive and perineal radical prostatectomy vs retropubic radical prostatectomy experienced fewer 30-day complications (14.2% and 14.9% vs 17.5%, p = 0.001), blood transfusions (2.2% and 3.6% vs 9.1%, p <0.001) and anastomotic strictures (6.8% and 8.5% vs 12.9%, p <0.001), and shorter median length of stay (1 and 2 days, respectively, vs 4, p <0.001). On adjusted analysis minimally invasive vs retropubic radical prostatectomy was associated with fewer 30-day complications (OR 0.78, 95% CI 0.66, 0.92), transfusions (OR 0.24, 95% CI 0.16, 0.34) and anastomotic strictures (OR 0.50, 95% CI 0.40, 0.62), and shorter length of stay (parameter estimate −0.53, 95% CI −0.58, −0.49). Similarly perineal vs retropubic radical prostatectomy was associated with fewer transfusions (OR 0.50, 95% CI 0.31, 0.82) and anastomotic strictures (OR 0.65, 95% CI 0.47, 0.90), and shorter length of stay (parameter estimate −0.53, 95% CI −0.42, −0.29). Conclusions: While the use of minimally invasive radical prostatectomy surged, men undergoing minimally invasive vs perineal radical prostatectomy experienced a lower risk of 30-day complications, blood transfusions and anastomotic strictures, and a shorter length of stay. Furthermore, perineal vs retropubic radical prostatectomy was also associated with relatively favorable outcomes. Further study is needed to assess continence, potency and cancer control. References 1 : Cancer statistics, 2008. CA Cancer J Clin2008; 58: 71. Google Scholar 2 : The changing face of low-risk prostate cancer: trends in clinical presentation and primary management. J Clin Oncol2004; 22: 2141. Google Scholar 3 : Laparoscopic radical prostatectomy: assessment after 240 procedures. Urol Clin North Am2001; 28: 189. Google Scholar 4 : Robotic-assisted laparoscopic prostatectomy: what is the learning curve?. Urology2005; 66: 105. Google Scholar 5 : An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg1995; 180: 101. Google Scholar 6 : A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis1987; 40: 373. Google Scholar 7 : Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol2003; 21: 401. Google Scholar 8 : Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience. Urology2007; 69: 311. Google Scholar 9 : Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology2002; 60: 864. Google Scholar 10 : Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. J Urol2007; 177: 929. Link, Google Scholar 11 : Laparoscopic resection for colon cancer–the end of the beginning?. N Engl J Med2004; 350: 2091. Google Scholar 12 : Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol2003; 169: 1689. Link, Google Scholar 13 : Robotic-assisted laparoscopic prostatectomy: do minimally invasive approaches offer significant advantages?. J Clin Oncol2005; 23: 8170. Google Scholar 14 : Laparoscopic radical prostatectomy: the Montsouris experience. J Urol2000; 163: 418. Link, Google Scholar 15 : Trends in the diffusion of laparoscopic nephrectomy. JAMA2006; 295: 2480. Google Scholar 16 : Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol2002; 167: 51. Link, Google Scholar 17 : An Apgar score for surgery. J Am Coll Surg2007; 204: 201. Google Scholar 18 : Life after radical prostatectomy: a longitudinal study. J Urol2001; 166: 587. Link, Google Scholar 19 : Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol2002; 168: 945. Link, Google Scholar 20 : Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol2003; 170: 1738. Link, Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byWeiner A, Murthy P, Richards K, Patel S and Eggener S (2018) Population Based Analysis of Incidence and Predictors of Open Conversion during Minimally Invasive Radical ProstatectomyJournal of Urology, VOL. 193, NO. 3, (826-831), Online publication date: 1-Mar-2015.Sharma V and Meeks J (2018) Open Conversion during Minimally Invasive Radical Prostatectomy: Impact on Perioperative Complications and Predictors from National DataJournal of Urology, VOL. 192, NO. 6, (1657-1662), Online publication date: 1-Dec-2014.Lowrance W, Elkin E, Jacks L, Yee D, Jang T, Laudone V, Guillonneau B, Scardino P and Eastham J (2018) Comparative Effectiveness of Prostate Cancer Surgical Treatments: A Population Based Analysis of Postoperative OutcomesJournal of Urology, VOL. 183, NO. 4, (1366-1372), Online publication date: 1-Apr-2010. Volume 180Issue 5November 2008Page: 1969-1974 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordscomplicationsprostatectomyprostateminimally invasiveoutcome assessment (health care)surgical proceduresMetricsAuthor Information Jim C. Hu Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts More articles by this author Nathanael D. Hevelone Center for Outcomes and Policy Research, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts More articles by this author Marcos D. Ferreira Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Stuart R. Lipsitz Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Toni K. Choueiri Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts More articles by this author Martin G. Sanda Division of Urologic Surgery, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Craig C. Earle Center for Outcomes and Policy Research, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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