Robot-assisted prostate cancer surgery as safe but more expensive as open surgery in older men

May 19, 2014

Minimally invasive robot-assisted surgery, which has become the main choice for surgically removing cancerous prostate glands during recent years, is as safe as open surgery for Medicare patients over age 65.

Those are the primary findings of a newly published nationwide patient survey that included participation by researchers at Henry Ford Hospital, a pioneer of robot-assisted radical prostatectomy (RARP).

"Although studies comparing the two techniques were done early in the robotic era for this surgery, RARP boomed in more recent years, overtaking ," says Jesse D. Sammon, D.O., a researcher at Henry Ford's Vattikuti Urology Institute and co-author of the study.

"Those early studies may no longer apply to contemporary patients, so we chose to compare the two procedures during the latter part of the last decade, after RARP became widely accepted."

The new study was presented at the annual meeting of the American Urological Association.

As of 2009, more than 60 percent of all radical prostatectomies in the U.S. were done robotically.

Drawing on several nationwide databases, the researchers identified 5,915 prostate cancer patients older than 65 but younger than 80 whom were Medicare beneficiaries and underwent either procedure from October 2008 to December 2009. RARP and open (ORP) – the gold standard for treating prostate cancer for decades before the robotics era – were then compared by post-operative complications, blood transfusions, prolonged length of stay (pLOS), readmission, additional cancer therapies and costs of care within the first year after surgery.

"In earlier studies, we had found that the minimally invasive approach was associated with lower rates of postoperative complications, blood transfusions and prolonged length of hospital stay compared with open surgery," Dr. Sammon says.

"However, these patients were younger than 65 and with the current study, we wanted to see if the differences held true in older patients."

The results of the study:

  • Patients treated with RARP and open surgery had similar risks of 30-day complications, but RARP patients had fewer overall complications at 90 days.
  • RARP patients had higher risks of genitourinary and miscellaneous medical complications.
  • The odds of RARP patients receiving a blood transfusion were four times lower than in ORP, and the length of stay was three times lower.
  • As shown previously, costs were higher in the robotic group, averaging $1,400 per patient during the first year after surgery.

"Although studies in younger patients showed that RARP had an advantage over open surgery in terms of outcomes," Dr. Sammon explains, "our new study of Medicare patients over age 65 showed that while it is safe, the robot-assisted procedure was not safer than open surgery.

"And while RARP offers significantly lower risk of blood transfusions and shorter hospital stays, these advantages were balanced by a 10% increase in charges relative to open surgery. This study underscores the importance of surgical experience as well as surgical approach in elderly ".

Explore further: Hospital surgical volume should be considered when judging value of procedures

Related Stories

Hospital surgical volume should be considered when judging value of procedures

May 5, 2013
The volume of cases performed at an institution each year has a direct effect on the outcome of surgical procedures, and should always be considered when looking at the benefits of a technique, according to a team of researchers ...

Fewer complications, better outcomes with robot-assisted prostate cancer surgery

April 24, 2012
Robot-assisted surgery is now both more common and far more successful than radical "open" surgery to treat prostate cancer in the United States, according to a new Henry Ford Hospital study published in the current issue ...

Robotic-assisted prostate cancer surgery drives up costs

May 23, 2012
In one of the most comprehensive analyses to date of the cost of robotic-assisted, laparoscopic surgery for prostate cancer, researchers at UPMC found that this now-dominant surgical approach is significantly more costly ...

Study finds robotic-assisted prostate surgery offers better cancer control

February 28, 2014
An observational study from UCLA's Jonsson Comprehensive Cancer Center has found that prostate cancer patients who undergo robotic-assisted prostate surgery have fewer instances of cancer cells at the edge of their surgical ...

Robot-assisted kidney cancer surgery offers many benefits, but at a cost

May 7, 2013
Robot-assisted surgery to remove kidney cancers has seen a rapid increase in use, and has both replaced and proven safer than laparoscopic procedures for the same purpose, according to a study by the Vattikuti Urology Institute ...

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.