Surgical Outcomes Are Questioned

A popular minimally invasive prostate cancer procedure increases a patient’s risk for erectile dysfunction and incontinence, Harvard researchers reported last week in the Journal of the American Medical Association.

Led by Jim C. Hu, genitourinary surgeon at the Harvard-affiliated Brigham and Women’s Hospital, the study assessed the long-term outcomes of radical prostatectomy, the procedure used to completely remove the prostate gland.

Using Medicare data for nearly 9,000 patients, Hu compared the number of claims filed for complications resulting from the decade-old minimally invasive form of radical prostatectomy with claims following the older, traditional form of the surgery.

Based on the claims, he observed a higher rate of erectile dysfunction and incontinence among those who had undergone the minimally invasive procedure.

But Hu, who is one of the largest providers of minimally invasive surgeries in Boston, attributes much of the difference to surgeon skill levels.

According to Hu, advertising campaigns have increased the patient demand for the minimally invasive surgery and have encouraged less skilled surgeons to perform them.

While the FDA only requires a two-day certification course for a robotic surgery license, Hu said the surgery is difficult to master.

“The learning curve for doing one well is easily several hundred,” he said.

The minimally invasive approach, which involves four to six small incisions and robot assistance, has grown in popularity because of its lower rate of blood transfusion and shorter recovery time.

According to Hu, these surgeries now account for 75 percent of all radical prostatectomies.

While Jerome P. Richie, the chief of urology at Brigham and Women’s Hospital, said that the study was a good way to compare the two procedures, he critiqued the study’s use of Medicare patients because this limited the population to those over 65 while the median age of those with prostate cancer is in the high 50s.

Hu cautioned that the results of this study should not discourage people from undergoing the less invasive surgery. Instead, he encouraged patients to seek out experienced doctors to perform the procedure.

“Patients need to inquire more of their surgeons,” Richie said. “In expert hands, the difference between open and robotic surgeries is relatively small.”