MINIMALLY INVASIVE RADICAL PROSTATECTOMY IS A MAJOR SURGERY
Contribução do Dr. Aloysio Toledo:
Da "Technical University of Dresden", o chairman Manfred P. Wirth escreveu
interessante artigo no Eur Urol 57 (2010) 750-751:
"Robot-Assisted Radical Prostatectomy: The New Gold Standard?"
Permitindo-me abreviá-lo, selecionei o seguinte trecho: à página 751, 3º e
4º parágrafos:
"Marketing of RARP focuses on issues like less pain, a shorter hospital
stay, earlier return to normal daily activities, and smaller incisions,
items that are largely irrelevant in the radical prostatectomy setting.
After RP, the functional outcome (ie, continence and potency) is a major
concern in addition to complete eradication of the tumor. It is impossible
to weigh the value of "minimal invasiveness" against the adverse impact of
compromised continence rates. Recognizing these facts may be difficult for
patients who are looking for an optimal treatment for their prostate
cancer amid the advertising noise to which they are currently exposed.
Patients confronted with the diagnosis of a malignant disease are
vulnerable to information suggesting an easy way to cure.
Regret of treatment choice and dissatisfaction with outcome after noticing
that so-called minimally invasive radical prostatectomy is, nevertheless,
major surgery with the potential for serious side effects may be the
consequence of this misunderstanding.
Open retropubic radical prostatectomy performed by an experienced surgeon
using unspectacular aides like loops and a headlight needs to be beaten
not in terms of painkiller use but in terms of continence and potency rates
as well as in terms of cost efficiency and oncologic outcome.
Performing a well-established procedure using robots and cameras as
effectively and safely as before is not necessarily an advancement in
health care; increasing tumor control, decreasing side effects, and
improving access to health care by limiting costs would be."