Surgeon experience trumps method of operation in patient outcomes for prostate surgery, UT Southwestern physician reports
DALLAS – April 26, 2010 – Patients who are considering surgery for prostate cancer should be swayed more by surgeon experience than by the technique used for the actual procedure, according to a UT Southwestern Medical Center physician.
Dr. Yair Lotan, associate professor of urology, said a patient’s anatomy and a surgeon’s experience in performing either open surgery or robot-assisted laparoscopic surgery for prostate removal best dictates patient recovery. Dr. Lotan’s editorial comment accompanies a study in the April issue of the Journal of Urology by researchers from the Department of Surgery at Memorial Sloan-Kettering Cancer Center.
The New York-based researchers evaluated the outcomes for either laparoscopic, robot-assisted prostate surgery or open surgery in 5,923 men ages 66 and older. They found no statistically significant differences in the rates of general medical or surgical complications between the two techniques. In robot-assisted cases, however, there was a correlating decrease in length of hospital stay.
“Obviously, you want a surgeon who is experienced and comfortable with the technique they use and one who has done the surgery often and with excellent patient outcomes,” said Dr. Lotan. “There are many factors that influence a patient’s decision to have surgery. If you go to a surgeon just because he or she is using a robot, that doesn’t mean your outcomes will be significantly better compared with open surgery.”
According to federal statistics, there are almost 170,000 new cases of prostate cancer diagnosed each year in the U.S. About 67,000 of these men will opt for surgical treatment, which typically involves removal of the diseased prostate, the surrounding lymph nodes and any tissue that may be cancerous.
In the open procedure, surgeons make an incision between the navel and pubic bone and remove the prostate and pelvic lymph nodes. The entire procedure typically takes between two and four hours, depending on the amount of tissue removed and degree of preservation of nerve endings.
For robot-assisted laparoscopic surgery, surgeons make smaller incisions in the patient’s lower abdomen through which a small camera and specialized surgical instruments are inserted.
“A concern for the authors of this paper is the patient’s perception that a robotic-assisted procedure is a superior procedure,” Dr. Lotan wrote in his editorial. “This perception is often reinforced by advertising from industry and physicians. The main information that a patient must know is not the prostatectomy approach, but surgeon experience.”
Patients should educate themselves on an individual surgeon’s experience and procedural outcomes before making a choice, Dr. Lotan said.
“Often consumers scrutinize other more trivial decisions more than they weigh a decision as major as surgery,” he said. “The best advice is to talk to your surgeon and ask them for specifics on their own data.”
Visit www.utsouthwestern.org/urology to learn more about UT Southwestern’s clinical services in urology.
Media Contact: Katherine Morales
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