ORLANDO, FL USA (UroToday.com) - Minimally invasive radical prostatectomy (MIRP) is now the most common approach for the treatment of prostate cancer. Numerous open surgeons have followed suit in adopting the minimally invasive technique. Anderson and colleagues’ objectives were to describe the pattern of MIRP adoption among surgeons and assess whether open surgeons who adopted this technique had worse outcomes to surgeons who only performed MIRP.
Anderson and colleagues using the SEER-Medicare dataset, identified all surgeons who performed MIRP or open radical prostatectomy (ORP) for prostate cancer from 2002-2008. The authors calculated the proportion of surgeons that had converted to the minimally invasive technique from their previous method of open radical nephrectomies each year. They also reported on incontinence, erectile dysfunction, and bladder outlet obstruction after the procedures.
Overall, they identified 750 MIRP surgeons, of which 450 were converters from the open technique while 300 had not performed open radical prostatectomy. The average number of surgeons that converted to MIRP was 75. Interestingly, surgeons that converted to MIRP performed a higher percentage of MIRPs than the surgeons that did not have any open radical prostatectomy experience (65% vs. 35%). From 2003 to 2008, the authors also reported the median cases that converters performed minimally invasively increased to 100%. Converters, based, on their results, had a higher rate of erectile dysfunction (OR of 1.48). There were, however, no differences in the use of secondary cancer treatments and incontinence or bladder outlet obstruction between converters and surgeons who performed exclusively MIRP
The authors concluded that open surgeons are rapidly moving towards minimally invasive radical prostatectomy. Given that previous open surgeons may not have the same level of training in MIRP, their surgical outcomes may be different. It will be beneficial to incorporate training in MIRP for urologists. Other factors that may influence the differences between the two groups is the learning curve for converters, as findings in the study showed that it took 3 years for converters to fully implement MIRP in their treatment strategies.
Presented by Christopher Anderson, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
New York, NY USA
Written by Garen Abedi, MD, University of California (Irvine), and medical writer for UroToday.com