Robotic surgeries and open for prostate cancer to achieve the same quality of life outcomes at 3 months -
Early results suggest a similar quality life outcomes at 3 months, but longer follow -up is now necessary more test 2 years
the first randomized controlled trial to compare robotic surgery directly to open surgery for patients with localized prostate cancer found that robotic surgery open and get similar results in terms of quality of key indicators of life at 3 months. The study, published in The Lancet is the first step of a test and quality reporting of results in life such as urinary and sexual function 2 years. In the longer term follow-up is now needed to fully assess the results of both techniques, including cancer survival.
Since the use of laparoscopic prostatectomy robotic-assisted (RALP) was first reported in 00, he has been rapid adoption of robotic surgery for men with prostate cancer. A million men are diagnosed with prostate cancer in the world each year. The most common treatment for localized disease is surgery to remove the prostate gland, and some men experience urinary and erectile problems after surgery. For most men, the operation will get rid of cancer cells, but for about one in three men, the cancer cells can return some time after the operation.
In the US, 80-85% of prostatectomies are done robotically, and although the proportion is lower in the UK and Europe, it increases. Robotic surgery is more expensive than open surgery (the initial cost of the robot is about 1.5 million £) and to date, there have been no randomized controlled trials comparing robot to open surgery .
"Surgery has long been the dominant approach for localized cancer of the prostate treatment, with many clinicians now recommending robotic method for patients. Many clinicians argue that the benefits of robotics technology leadership to improve the quality of life and oncological results. Our randomized trial, the first of its kind, found no statistical difference in the quality of life outcomes between the two groups at 12 weeks of follow-up. now patients are followed for a total of 2 years to fully assess the long-term outcomes, including cancer survival, "says lead author, Professor Robert Frank Gardiner, University of Queensland Centre for clinical research Brisbane, Australia. "in the meantime, patients should choose an experienced surgeon that they trust and with whom they have a relationship, rather than basing their decision on a specific surgical approach."
RALP uses a high magnification (x10) 3D camera allows the surgeon to see inside the patient's abdomen through a keyhole incision. The device is connected to one of the four arms of the robot - the other three hold other surgical instruments needed for the operation. The surgeon in the operating room, but is away from the patient and controls the robotic arms to perform the operation (link to pictures below). Robot-assisted surgery is most often used for prostatectomies, but is increasingly used in gynecology, cardiothoracics, head and neck, and general surgery, and other operations in urology.
308 men with prostate cancer were included in the study and were randomized to receive either the robot-assisted surgery (157) or open surgery (radical prostatectomy) (151) and were followed for 12 weeks after the operation. All operations were carried out by two surgeons at the Royal Brisbane and Women's Hospital.
The main findings included the urinary and sexual function at 12 weeks and there was no difference between the two groups. There is also no difference in the number of postoperative complications. Patients who underwent open surgery spent more time in the hospital after surgery, but on average, both groups spent the same number of working days.
Patients who underwent open surgery lost on average three times more blood (although no transfusion was required during operations because blood was recycled in patients during opening operations ). After the surgery, patients who underwent robotic surgery experienced less pain doing day to day activities (1 week), and better overall physical quality of life (6 weeks). Well over time, differences leveled and became non-significant at 12 weeks.
The authors note that the urinary and sexual function can continue to improve up to 3 years after surgery, so the differences in results between the two groups could appear later. The study is the first step of a two-year trial
Writing in a linked comment, Professor Ara Darzi, Imperial College London, UK said :.
The clinical community is waiting impatiently for 1 year oncologic outcomes; the last patient underwent surgery in March, 2015. This will be the interpretation of the long-term functional and oncologic results that reveal the full implications of this study for clinical practice ... tests that show the equivalence of an innovation sometimes interpreted as supporting a return to the existing practice, including rediverting the formation of a generation of surgeons who could have followed the evolution of innovation. Equivalence and non-inferiority should also be considered positive, showing innovation has preserved its intended use and well-established surgery as good oncologic results balanced against acceptable functional side effects. These are the advances in applied technology, reducing the trauma of access and invasiveness of surgery, which also provide the platform on which to develop ancillary technological innovations to further improve the quality and safety surgery. Our challenge as a community is to demonstrate the translation to the sides of major health and economic impact safe and profitable.
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