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Mixed Outcomes in Laparoscopy for Prostates
May 27, 2008
Laparoscopic operations for prostate cancer, a minimally invasive surgery that is in rising demand, result in fewer immediate complications and quicker recovery than the more common open procedure, a new study reports. But the surgery increases the chance for longer term problems that require further therapy, the research says.
Our Review Summary
This newspaper article reports on the findings of a study that compares prevalence and outcomes of minimally invasive laparoscopic prostate removal with the standard "open" surgical method. The findings, published in the Journal of Clinical Oncology provide a useful snapshot at a time when laparoscopic surgery is rapidly becoming popular.
The news article does a solid job of describing the findings in detail and providing comments from independent sources who help interpret them. The reader takes away the idea that laparoscopic surgeries, despite their increased popularity, appear to have significant potential harms.
But the article leaves some major questions unanswered.
First, the newspaper report does not mention costs. Robot-assisted procedures are inherently controversial because the equipment is so costly but the benefits unknown. By not mentioning costs of the surgery, the article strips the findings of context.
Second, the study itself looks at a very narrow question--it compares the two surgical approaches in a 65-plus population. But the analysis did not account for disease state, mortality, the side effects of surgery men are most likely to care about (impotence and incontinence), or even whether the laparoscopic procedures were robot-assisted. The possibility that selection bias colors the findings is obvious.
This is an important piece of research in the field. But given its limitations, it's not clear that reporting on the findings to a large audience has much public value.
Click on Criteria for definitions.
The story implies that laparoscopic prostatectomies are widely available, and in fact are done about a third of the time in the studied population.
But it would have been useful to state how difficult it is (or is not) to find a surgeon experienced with laparoscopic procedures.
The story does not report how much the laparoscopic surgery costs, either directly or over time due to fewer complications or more treatments.
One assumes that robot-assisted surgeries are more expensive, though again the story should have specified. Given the possibility of economic self-interest by proponents of laparoscopic surgery, this information would have been very useful.
A daVinci machine reportedly costs over a million dollars, with signficant annual maintenance costs in addition.
The story does nothing to exaggerate the complications of prostatectomy or the success of the procedures studied.
The article is based on a retrospective study of outcomes in a large population, conducted by university researchers and published in a major peer-reviewed journal.
However, there have been no head-to-head randomized trials comparing open vs. laparoscopic prostatectomies. Since outcomes in observational studies are subject to selection bias, the article should have plainly indicated this.
The story explictly compares the harms of the two surgical approaches in terms of short-term complications and longer-term consequences.
The story plainly states that the procedure is increasingly common and widely advertised. It cites figures from the study that demonstrate the increase of use between 2003 and 2005.
The article does a thorough job of describing the findings by specifying the percentage of patients who had minor and more serious complications. It also compares days spent in the hospital.
However, the article reports a 27 percent reduction in risk of short-term complications and a 40 percent greater risk of scarring without indicating the underlying risks for either of these outcomes. See our primer on absolute versus relative risk statements.
It does not appear that a press release is associated with this journal article.
The article uses as sources the study itself, the lead author, and two independent medical specialists. This is sufficient sourcing.
It is not known if any of the researchers had ties to interested parties such as device makers. The published abstract does not include this information.
The article, like the study upon which it is based, compares only two treatment options--miniminally invasive laparoscopic surgery and traditional "open" surgery to remove the prostate.
It would have been helpful, but not necessary, to place these two approaches in the context of the many choices men with prostate cancer face based on age, severity, co-morbidities, personal preference and other factors.
Total Score: 7 of 9 Satisfactory
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The website NoFreeLunch.org posts "a database of health care professionals who have pledged to accept no gifts from industry and to rely on non-promotional sources of information."
To help journalists cover stories responsibly, we post a list of independent experts who state that they do not have financial ties to drug or medical device manufacturers.
We apply the same ten standardized criteria to the review of every story.
We have about 30 story reviewers. Each story is reviewed by 3 different people.
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Our reviewers include two former CNN medical reporters and a former editor of the Washington Post health section.