Utilization and Outcomes of Minimally Invasive Radical Prostatectomy Jim C. Hu, Qin Wang, Chris L. Pashos, Stuart R. Lipsitz, and Nancy L. Keating From the Division of Urologic Surgery; Center for Surgery and Public Health; Division of General Internal Medicine, Brigham and Women’s Hospital; Department of Health Care Policy, Harvard Medical School, Boston, MA; and the Abt Associate Clinical Trials, Bethesda, MD. Submitted July 11, 2007; accepted January 3, 2008. Supported by a Lance Armstrong Young Investigator Award and a Dana Farber/Harvard Cancer Center Career Development Award (J.C.H.); and by an intramural grant by the Brigham and Women’s Center for Surgery and Public Health. Authors’ disclosures of potential con- flicts of interest and author contribu- tions are found at the end of this article. Corresponding author: Jim C. Hu, MD, MPH, Division of Urologic Surgery, Brigham and Women’s Hospital, Boston, MA 02115; e-mail: jhu2@ partners.org. © 2008 by American Society of Clinical Oncology 0732-183X/08/2614-2278/$20.00 DOI: 10.1200/JCO.2007.13.4528 A B S T R A C T Purpose Demand for minimally invasive radical prostatectomy (MIRP) to treat prostate cancer is increasing; however, outcomes remain unclear. We assessed utilization, complications, lengths of stay, and salvage therapy rates for MIRP versus open radical prostatectomy assessed whether MIRP surgeon volume is associated with better outcomes. Methods We identified 2,702 men undergoing MIRP and open radical prostatectomy during 2003 to 2005 from a national 5% sample of Medicare beneficiaries. We assessed the association between surgical approach and outcomes, adjusting for surgeon volume, age, race, comorbidity, and geographic region. Results MIRP utilization increased from 12.2% in 2003 to 31.4% in 2005. Men undergoing MIRP versus open radical prostatectomy had fewer perioperative complications (29.8% v 36.4%; P  .002) and shorter lengths of stay (1.4 v 4.4 days; P  .001); however, they were more likely to receive salvage therapy (27.8% v 9.1%, P  .001). In adjusted analyses, MIRP versus open radical prostatectomy was associated with fewer perioperative complications (odds ratio [OR], 0.73; 95% CI, 0.60 to 0.90), shorter lengths of stay (parameter estimate, 2.99; 95% CI, 3.45 to 2.53) but more anastomotic strictures (OR, 1.40; 95% CI, 1.04 to 1.87) and higher rates of salvage therapy (OR, 3.67; 95% CI, 2.81 to 4.81). Patients of high-volume MIRP experienced fewer anastomotic strictures (OR, 0.93; 95% CI, 0.87 to 0.99) and less salvage therapy (OR, 0.92; 95% CI, 0.88 to 0.98). Conclusion Men undergoing MIRP versus open radical prostatectomy have lower risk for perioperative complications and shorter lengths of stay, but are at higher risk for salvage therapy and anastomotic strictures. However, risk for these unfavorable outcomes decreases with increasing MIRP surgical volume. J Clin Oncol 26:2278-2284. © 2008 by American Society of Clinical Oncology INTRODUCTION One in six men in the United States will develop prostate cancer in his lifetime, and prostate cancer is the second leading cause of cancer mortality in men. 1 Radical prostatectomy remains the most common treatment choice in the United States, 2,3 accounting for one half of the $1.7 billion spent annually on prostate cancer. 4 Presently, men opting for surgery must choose between open and mini- mally invasive radical prostatectomy with limited data demonstrating differences in outcomes. Although the use of minimally invasive radical prostatectomy has increased in recent years, few data are available about utilization and outcomes compared with open radical prostatectomy. Moreover, while in- creased surgeon volume is associated with better out- comes for open radical prostatectomy, 5,6 there is an absence of data regarding whether volume-outcome effects exist for minimally invasive radical prostatec- tomy. This is particularly relevant given descriptions of steep learning curves 7,8 and increased complications associated with rapid adoption of minimally invasive surgical approaches for other procedures. 9,10 To explore utilization and outcomes of minimally invasive radical prostatectomy, we performed a population-based study of Medi- care beneficiaries undergoing radical prostatec- tomy during 2003 to 2005. In particular, we examined whether complications, lengths of stay, and need for salvage therapy were compa- rable after minimally invasive versus open rad- ical prostatectomy. Furthermore, among men undergoing minimally invasive radical prosta- tectomy, we assessed whether surgeon volume was associated with better outcomes. JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 26  NUMBER 14  MAY 10 2008 2278 © 2008 by American Society of Clinical Oncology Downloaded from ascopubs.org by 54.87.62.191 on June 14, 2022 from 054.087.062.191 Copyright © 2022 American Society of Clinical Oncology. All rights reserved.