Utilization and outcomes of minimally invasive radical prostatectomy: Hu JC, Wang Q, Pashos CL, Lipsitz SR, Keating NL, Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA

Abstract

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 vs. open radical prostatectomy assessed whether MIRP surgeon volume is associated with better outcomes. 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. MIRP utilization increased from 12.2% in 2003 to 31.4% in 2005. Men undergoing MIRP vs. open radical prostatectomy had fewer perioperative complications (29.8% vs. 36.4%; P = 0.002) and shorter lengths of stay (1.4 vs. 4.4 days; P < 0.001); however, they were more likely to receive salvage therapy (27.8% vs. 9.1%, P < 0.001). In adjusted analyses, MIRP vs. 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). Men undergoing MIRP vs. 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.