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 specimen and less need for additional cancer treatments
like hormone or radiation therapy than patients who have traditional
"open" surgery. The study, published online Feb. 19 in the journal European Urology,
was led by Dr. Jim Hu, UCLA's Henry E. Singleton Professor of Urology
and director of robotic and minimally invasive surgery in the urology
department at the David Geffen School of Medicine at UCLA. Although it is becoming more popular, robotic-assisted radical
prostatectomy -- the complete removal of the prostate using a robotic
apparatus -- remains controversial because there has been little
evidence that it provides better cancer control than open radical
prostatectomy, the traditional surgical approach, which is less costly.
In an effort to determine whether or not robotic surgery offered an
advantage, Hu and his colleagues compared 5,556 patients who received
robotic surgery with 7,878 who underwent open surgery between 2004 and
2009. Data was provided by the Surveillance, Epidemiology, and End
Results-Medicare, a program of cancer registries that collect clinical
and demographic information on people with cancer.
The
researchers looked at the surgical margin status of the two groups,
which is the amount of cancer cells at the edge of the removed prostate
specimen. A positive margin -- the presence of cancer cells at the edge
-- may result from cutting through the cancer and leaving some behind
rather than cutting around the cancer completely. In prostate cancer,
this has been shown to lead to a greater risk of recurrence and death
from the disease.
The team also assessed the use of additional
cancer therapies -- a hormone therapy known as androgen deprivation, as
well as radiation -- after robotic surgery and open surgery.
They
found that robotic prostate surgery was associated with 5 percent fewer
positive margins (13.6 percent vs. 18.3 percent); this difference was
greater for patients with intermediate and high-risk prostate cancer.
Patients who had robotic surgery also had a one-third reduction in the
likelihood of needing additional cancer therapies within 24 months after
surgery.
Despite the greater up-front cost of robotic surgery,
the findings show that the procedure may translate into less downstream
costs and fewer side effects from radiation and hormone therapy, the
researchers said.
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