I was going to share with you an opinion piece in which several doctors from the Mayo Clinic comment on a study by Dr. Hu of Harvard, which compared outcomes for laparascopic (which includes robotic) and traditional open surgery for prostate cancer. I had some resistance to posting this information because I know it’s not what people want to hear and I thought they might not listen. But today in the NY Times there is an article about the Hu study called, “Mixed Outcomes in Laparoscapy for Prostates“. If the NYT thinks this is an important enough health issue to highlight, I will take a chance on it.
The Hu study showed that despite a track record of lower complications during and immediately after surgery, laparascopic surgery proved deficient in a number of other ways. There was more scarring, potentially necessitating more surgery. And the rate of anastomic strictures, or as they put it, “urinary quality of life”, was worse in laparoscopic patients. Worst of all, the oncologic outcomes (successfully removing the cancer) were significantly worse in men who had minimally invasive surgery. Other studies have shown the same.
The number of laparoscopic surgeries performed in the U.S. has skyrocketed in recent recent years. At present, one in 3 prostate surgery patients will undergo minimally invasive surgery. Consider that the number of laparascopic prostatectomies done increased by 20% between 2003 and 2005. This, unfortunately, is not because of merit, but because laparascopic prostate surgery, especially robotic, has been heavily marketed to doctors and patients. And don’t forget the profit motive: American doctors are far more likely to recommend surgery in general, because, unlike European doctors, they are paid per procedure. And a doctor who invests in a da Vinci robot will also want to make a profit from that investment.
So what kind of defects did the Hu study find in laparascopic surgery? I’m quoting from the Times:
“But the men who had laparoscopies had a 40% increase in scarring that interferes with organ function, a complication that requires additional surgery. And within 6 months of their operations, more than one-quarter needed additional hormone or drug therapy compared with 1 in 10 of those who had conventional surgery.”
This last sentence is sobering: it says that laparoscopic surgery failed to remove the cancer in significantly more cases than did open surgery. Therefore, additional treatment was required. Ultimately, removal of the cancer is the only thing that matters.
I will add some information from the Hu article that was not in the Times. Fortunately, when you look deeper into the results, you find that the rate of success with laparoscopy compares with that of open surgery in cases where the surgeon is more experienced. Unfortunately, there are a lot of urologists who are performing minimally invasive prostate surgery who are