Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy
CONTEXT Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP). OBJECTIVE To determine the comparative effectiveness of MIRP vs RRP. DESIGN, SETTING, AND PATIENTS Population-bas...
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| creator | Hu, Jim C Gu, Xiangmei Lipsitz, Stuart R Barry, Michael J D’Amico, Anthony V Weinberg, Aaron C Keating, Nancy L |
| description | CONTEXT Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP). OBJECTIVE To determine the comparative effectiveness of MIRP vs RRP. DESIGN, SETTING, AND PATIENTS Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899). MAIN OUTCOME MEASURES We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control. RESULTS Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval [CI], 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least $60 000 (35.8% vs 21.5%) (all P |
| doi_str_mv | 10.1001/jama.2009.1451 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67689083</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>184709</ama_id><sourcerecordid>1886742421</sourcerecordid><originalsourceid>FETCH-LOGICAL-a474t-f0a9c1ea4754789b117971ab74c637e6088856a6c0fea50fd43fdcee8a1ed2563</originalsourceid><addsrcrecordid>eNpdkNtLwzAUh4Mobk5fBV-kCPrWmTRpLo8ypg42JqLP4SxNoKM3m26w_96UlQkmD7nwnV9yPoRuCZ4SjMnzFkqYJhirKWEpOUNjklIZ01TJczQO1zIWTLIRuvJ-i8MgVFyiEVEy4ThJx2g1q8sGWujyvY3mzlnT7yrrfVS7aJVXeQlFcYgW1R58z-x9tG5sFX1Clhsooo-29h10oa4uD9fowkHh7c2wTtD36_xr9h4v12-L2csyBiZYFzsMyhAbDikTUm0IEUoQ2AhmOBWWYyllyoEb7Cyk2GWMusxYK4HYLEk5naCnY27T1j876ztd5t7YooDK1juvueBSYUkD-PAP3Na7tgp_0wkhjCZcqQBNj5AJvfjWOt20oe32oAnWvWXdW9a9Zd1bDgX3Q-puU9rsDx-0BuBxAMAHSa6FyuT-xCUJDpP3L98duT7_lCKZwIr-Apk7jT0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211432699</pqid></control><display><type>article</type><title>Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Hu, Jim C ; Gu, Xiangmei ; Lipsitz, Stuart R ; Barry, Michael J ; D’Amico, Anthony V ; Weinberg, Aaron C ; Keating, Nancy L</creator><creatorcontrib>Hu, Jim C ; Gu, Xiangmei ; Lipsitz, Stuart R ; Barry, Michael J ; D’Amico, Anthony V ; Weinberg, Aaron C ; Keating, Nancy L</creatorcontrib><description>CONTEXT Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP). OBJECTIVE To determine the comparative effectiveness of MIRP vs RRP. DESIGN, SETTING, AND PATIENTS Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899). MAIN OUTCOME MEASURES We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control. RESULTS Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval [CI], 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least $60 000 (35.8% vs 21.5%) (all P < .001). In propensity score–adjusted analyses, MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days; P<.001) and lower rates of blood transfusions (2.7% vs 20.8%; P < .001), postoperative respiratory complications (4.3% vs 6.6%; P = .004), miscellaneous surgical complications (4.3% vs 5.6%; P = .03), and anastomotic stricture (5.8% vs 14.0%; P < .001). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%; P = .001) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years; P = .02) and erectile dysfunction (26.8 vs 19.2 per 100 person-years; P = .009). Rates of use of additional cancer therapies did not differ by surgical procedure (8.2 vs 6.9 per 100 person-years; P = .35). CONCLUSION Men undergoing MIRP vs RRP experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2009.1451</identifier><identifier>PMID: 19826025</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Cohort Studies ; Comparative studies ; Effectiveness studies ; Erectile Dysfunction - epidemiology ; General aspects ; Health Services Research ; Humans ; Length of Stay ; Male ; Medical sciences ; Mens health ; Minimally Invasive Surgical Procedures ; Postoperative Complications - epidemiology ; Prostate ; Prostate cancer ; Prostatectomy - methods ; Surgery ; Transurethral Resection of Prostate ; Treatment Outcome ; United States ; Urinary Incontinence - epidemiology</subject><ispartof>JAMA : the journal of the American Medical Association, 2009-10, Vol.302 (14), p.1557-1564</ispartof><rights>2009 INIST-CNRS</rights><rights>Copyright American Medical Association Oct 14, 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a474t-f0a9c1ea4754789b117971ab74c637e6088856a6c0fea50fd43fdcee8a1ed2563</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.2009.1451$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2009.1451$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76231,76234</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22020269$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19826025$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hu, Jim C</creatorcontrib><creatorcontrib>Gu, Xiangmei</creatorcontrib><creatorcontrib>Lipsitz, Stuart R</creatorcontrib><creatorcontrib>Barry, Michael J</creatorcontrib><creatorcontrib>D’Amico, Anthony V</creatorcontrib><creatorcontrib>Weinberg, Aaron C</creatorcontrib><creatorcontrib>Keating, Nancy L</creatorcontrib><title>Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP). OBJECTIVE To determine the comparative effectiveness of MIRP vs RRP. DESIGN, SETTING, AND PATIENTS Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899). MAIN OUTCOME MEASURES We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control. RESULTS Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval [CI], 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least $60 000 (35.8% vs 21.5%) (all P < .001). In propensity score–adjusted analyses, MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days; P<.001) and lower rates of blood transfusions (2.7% vs 20.8%; P < .001), postoperative respiratory complications (4.3% vs 6.6%; P = .004), miscellaneous surgical complications (4.3% vs 5.6%; P = .03), and anastomotic stricture (5.8% vs 14.0%; P < .001). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%; P = .001) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years; P = .02) and erectile dysfunction (26.8 vs 19.2 per 100 person-years; P = .009). Rates of use of additional cancer therapies did not differ by surgical procedure (8.2 vs 6.9 per 100 person-years; P = .35). CONCLUSION Men undergoing MIRP vs RRP experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Comparative studies</subject><subject>Effectiveness studies</subject><subject>Erectile Dysfunction - epidemiology</subject><subject>General aspects</subject><subject>Health Services Research</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mens health</subject><subject>Minimally Invasive Surgical Procedures</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prostate</subject><subject>Prostate cancer</subject><subject>Prostatectomy - methods</subject><subject>Surgery</subject><subject>Transurethral Resection of Prostate</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Urinary Incontinence - epidemiology</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkNtLwzAUh4Mobk5fBV-kCPrWmTRpLo8ypg42JqLP4SxNoKM3m26w_96UlQkmD7nwnV9yPoRuCZ4SjMnzFkqYJhirKWEpOUNjklIZ01TJczQO1zIWTLIRuvJ-i8MgVFyiEVEy4ThJx2g1q8sGWujyvY3mzlnT7yrrfVS7aJVXeQlFcYgW1R58z-x9tG5sFX1Clhsooo-29h10oa4uD9fowkHh7c2wTtD36_xr9h4v12-L2csyBiZYFzsMyhAbDikTUm0IEUoQ2AhmOBWWYyllyoEb7Cyk2GWMusxYK4HYLEk5naCnY27T1j876ztd5t7YooDK1juvueBSYUkD-PAP3Na7tgp_0wkhjCZcqQBNj5AJvfjWOt20oe32oAnWvWXdW9a9Zd1bDgX3Q-puU9rsDx-0BuBxAMAHSa6FyuT-xCUJDpP3L98duT7_lCKZwIr-Apk7jT0</recordid><startdate>20091014</startdate><enddate>20091014</enddate><creator>Hu, Jim C</creator><creator>Gu, Xiangmei</creator><creator>Lipsitz, Stuart R</creator><creator>Barry, Michael J</creator><creator>D’Amico, Anthony V</creator><creator>Weinberg, Aaron C</creator><creator>Keating, Nancy L</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20091014</creationdate><title>Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy</title><author>Hu, Jim C ; Gu, Xiangmei ; Lipsitz, Stuart R ; Barry, Michael J ; D’Amico, Anthony V ; Weinberg, Aaron C ; Keating, Nancy L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a474t-f0a9c1ea4754789b117971ab74c637e6088856a6c0fea50fd43fdcee8a1ed2563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Comparative studies</topic><topic>Effectiveness studies</topic><topic>Erectile Dysfunction - epidemiology</topic><topic>General aspects</topic><topic>Health Services Research</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mens health</topic><topic>Minimally Invasive Surgical Procedures</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prostate</topic><topic>Prostate cancer</topic><topic>Prostatectomy - methods</topic><topic>Surgery</topic><topic>Transurethral Resection of Prostate</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Urinary Incontinence - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hu, Jim C</creatorcontrib><creatorcontrib>Gu, Xiangmei</creatorcontrib><creatorcontrib>Lipsitz, Stuart R</creatorcontrib><creatorcontrib>Barry, Michael J</creatorcontrib><creatorcontrib>D’Amico, Anthony V</creatorcontrib><creatorcontrib>Weinberg, Aaron C</creatorcontrib><creatorcontrib>Keating, Nancy L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hu, Jim C</au><au>Gu, Xiangmei</au><au>Lipsitz, Stuart R</au><au>Barry, Michael J</au><au>D’Amico, Anthony V</au><au>Weinberg, Aaron C</au><au>Keating, Nancy L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2009-10-14</date><risdate>2009</risdate><volume>302</volume><issue>14</issue><spage>1557</spage><epage>1564</epage><pages>1557-1564</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP). OBJECTIVE To determine the comparative effectiveness of MIRP vs RRP. DESIGN, SETTING, AND PATIENTS Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899). MAIN OUTCOME MEASURES We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control. RESULTS Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval [CI], 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least $60 000 (35.8% vs 21.5%) (all P < .001). In propensity score–adjusted analyses, MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days; P<.001) and lower rates of blood transfusions (2.7% vs 20.8%; P < .001), postoperative respiratory complications (4.3% vs 6.6%; P = .004), miscellaneous surgical complications (4.3% vs 5.6%; P = .03), and anastomotic stricture (5.8% vs 14.0%; P < .001). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%; P = .001) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years; P = .02) and erectile dysfunction (26.8 vs 19.2 per 100 person-years; P = .009). Rates of use of additional cancer therapies did not differ by surgical procedure (8.2 vs 6.9 per 100 person-years; P = .35). CONCLUSION Men undergoing MIRP vs RRP experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>19826025</pmid><doi>10.1001/jama.2009.1451</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Biological and medical sciences Cohort Studies Comparative studies Effectiveness studies Erectile Dysfunction - epidemiology General aspects Health Services Research Humans Length of Stay Male Medical sciences Mens health Minimally Invasive Surgical Procedures Postoperative Complications - epidemiology Prostate Prostate cancer Prostatectomy - methods Surgery Transurethral Resection of Prostate Treatment Outcome United States Urinary Incontinence - epidemiology |
| title | Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy |
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