1753 COMPARATIVE EFFECTIVENESS OF SURGICAL TREATMENTS FOR PROSTATE CANCER: A POPULATION-BASED ANALYSIS OF POSTOPERATIVE OUTCOMES

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You have accessJournal of UrologyProstate Cancer: Localized VII1 Apr 20101753 COMPARATIVE EFFECTIVENESS OF SURGICAL TREATMENTS FOR PROSTATE CANCER: A POPULATION-BASED ANALYSIS OF POSTOPERATIVE OUTCOMES William Lowrance, James Eastham, Lindsay Jacks, David Yee, Thomas Jang, Vincent Laudone, Bertrand Guillonneau, Peter Scardino, and Elena Elkin William LowranceWilliam Lowrance More articles by this author , James EasthamJames Eastham More articles by this author , Lindsay JacksLindsay Jacks More articles by this author , David YeeDavid Yee More articles by this author , Thomas JangThomas Jang More articles by this author , Vincent LaudoneVincent Laudone More articles by this author , Bertrand GuillonneauBertrand Guillonneau More articles by this author , Peter ScardinoPeter Scardino More articles by this author , and Elena ElkinElena Elkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1602AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Enthusiasm for laparoscopic surgical approaches to prostate cancer treatment has grown, despite limited evidence of improved outcomes compared with open radical prostatectomy. We compared laparoscopic (with or without robotic assistance) versus open radical prostatectomy in terms of postoperative outcomes and subsequent cancer-directed therapy. METHODS Using a population-based cancer registry linked with Medicare claims, we identified men age 66 or older with localized prostate cancer who received a radical prostatectomy from 2003-2005. Outcome measures were general medical/surgical complications and mortality within 90 days following surgery; genitourinary/bowel complications within 365 days; receipt of radiation therapy, androgen deprivation therapy or both within 365 days; length of hospital stay. RESULTS Of the 5,923 men,18% received a laparoscopic radical prostatectomy. Adjusting for patient and tumor characteristics, there were no differences in rates of general medical/surgical complications (OR 0.93; 95% CI: 0.77-1.14) or genitourinary/bowel complications (OR 0.96; 95% CI: 0.76-1.22) or in the use of postoperative radiation, androgen deprivation or both (OR 0.80; 95% CI: 0.60-1.08). Laparoscopic prostatectomy was associated with a 35% shorter hospital stay (p<0.0001) and a lower rate of bladder neck/urethral obstruction (OR 0.74; 95% CI 0.58-0.94). In laparoscopic patients, surgeon volume was inversely associated with length of hospital stay and the odds of any genitourinary/bowel complication. CONCLUSIONS Laparoscopic and open radical prostatectomy have similar rates of postoperative morbidity and use of additional treatment. Men considering prostate cancer surgery should understand the expected benefits and risks of each technique to facilitate decision-making and to set realistic expectations. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e677 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Lowrance More articles by this author James Eastham More articles by this author Lindsay Jacks More articles by this author David Yee More articles by this author Thomas Jang More articles by this author Vincent Laudone More articles by this author Bertrand Guillonneau More articles by this author Peter Scardino More articles by this author Elena Elkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...