PURPOSE: The number of radical prostatectomies has increased.
Many urologists have shifted from the open surgical approach to minimally invasive techniques. It is not clear whether the risk of post-prostatectomy incisional hernia varies by surgical approach.
MATERIALS AND METHODS: In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset we identified men age 66 and older who had minimally invasive (MIRP) or open radical prostatectomy (ORP) for prostate cancer diagnosed 2003-2007. The main outcome was incisional hernia repair identified in Medicare claims following prostatectomy. We also examined the frequency of umbilical, inguinal and other hernia repairs.
RESULTS: We identified 3,199 patients who had MIRP and 6,795 who had open radical prostatectomy ORP. The frequency of incisional hernia repair was 5.3% (median follow-up 3.1 years) in the MIRP group and 1.9% (median follow-up 4.4 years) in the ORP group, corresponding to incidence rates of 16.1 and 4.5 per 1000 person-years for MIRP and ORP, respectively. Compared with ORP, MIRP was associated with a more than 3-fold increased risk of incisional hernia repair, controlling for patient and disease characteristics (adjusted hazard ratio 3.39, 95% CI, 2.63-4.38, p < 0.0001). MIRP was associated with an attenuated but increased risk of any hernia repair compared with ORP (adjusted hazard ratio 1.48, 95% CI 1.29-1.70, p < 0.0001), driven by incisional hernias.
CONCLUSIONS: MIRP was associated with a significantly increased risk of incisional hernia compared with ORP. This is a potentially remediable complication of prostate cancer surgery that warrants increased vigilance with respect to surgical technique.
Written by:
Carlsson SV, Ehdaie B, Atoria CL, Elkin EB, Eastham JA. Are you the author?
Memorial Sloan-Kettering Cancer Center, Urology Service, Department of Surgery, New York, New York, USA; Sahlgrenska Academy at the University of Gothenburg, Department of Urology, Gothenburg, Sweden.
Reference: J Urol. 2013 May 17. pii: S0022-5347(13)04376-0.
doi: 10.1016/j.juro.2013.05.036
PubMed Abstract
PMID: 23688847
UroToday.com Prostate Cancer Section
