In The New York Times this morning, Roni Caryn Rabin reports on a JAMA study comparing traditional surgery for prostate cancer with minimally invasive surgery, in which a surgeon uses a camera and a robot operating through tiny incisions.

The lede says patients who received minimally invasive surgery were less likely to get pneumonia but more likely to suffer from incontinence and impotence.

Rabin attributes this information to “one of the largest studies to compare outcomes to date.” So: It’s important stuff.

I would guess that most prostate cancer patients who stopped reading at the lede would pick traditional surgery. Pneumonia is not a good thing to get, but, depending upon the patient’s age and health, that might be less frightening than incontinence or impotence.

But read further. Immediately following surgery, patients who had robotic surgery had a 4.7 percent risk of genital and urinary complications, Rabin writes. Those who had traditional surgery had a 2.1 percent risk. That doesn’t sound like a big difference to me. Patients who read that might come to a different conclusion.

These numbers come more than halfway through the article. Perhaps they should have been in the second or third graf?

Even lower in the story, we read that 18 months after surgery, the risks of incontinence were 15.9 percent (robot) vs. 12.2 percent (traditional).

The risks of impotence were 26.8 percent (robot) vs. 19.2 percent (traditional).

That wasn’t easy to decode; Rabin puts all that in one sentence that includes six numbers.  She also says 15.9 percent were at risk “each year.” I don’t know what that means.

Rabin offers an interesting interpretation of the study from one of the doctors she interviewed. He said the study shows that what’s important is the experience and skill of the surgeon–not the method he or she uses.

Unfortunately, that interesting take on the study appears in the last graf.

Other stories:

• LA Times – Shari Roan: Minimally invasive prostate surgery carries risks, study says ;
• Milwaukee Journal Sentinel – John Fauber: Robotic prostate surgery not better at reducing side effects, study finds ;
• Reuters – Julie Steenhuysen: New prostate surgery not necessarily better – study ;
• HealthDay – Ed Edelson: Impotence, Incontinence Risk Casts Doubt on High-Tech Prostate Surgery ;
• Boston Globe – Liz Kowalczyk : Study raises concerns about robotic prostate surgery ;
• AP – Carla K. Johnson: Robotic prostate surgery may mean big trade-off ;

- Paul Raeburn

This entry was posted on Wednesday, October 14th, 2009 at 11:19 am and is filed under Health & Medicine Stories. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.