New approach to prostate cancer
surgery
ANAHEIM, Calif. --
June 7, 2001 (Cancer Digest) -- In the first study of its kind,
a new procedure, called "fast track" prostate cancer
surgery may help men get home within 24 hours of having their
prostates removed with no added risk of complications.
The study was presented
this week at the American Urological Association's annual meeting
in Anaheim, Calif. by Dr. Martin Sanda from the University of
Michigan Comprehensive Cancer Center.
It showed that a 24-hour
approach compared well to conventional surgery, yielding high
patient satisfaction rates and low complication rates almost
exactly like those seen with standard care.
"Our findings
suggest a possible new standard of care that would lead to a
24-hour stay for most patients, if their surgery is performed
at centers specializing in prostate cancer care," Sanda
said in a press release.
"Since prostatectomy
is the most common treatment for early-stage prostate cancer,
and indeed is one of the most common cancer operations overall,
a more streamlined approach could have a major impact on both
patient experience and cost of care," he said.
Sanda and his colleagues
developed the treatment plan, which uses lower-body (epidural)
anesthesia, that avoids the "hangover" effect of general
anesthesia.
They combine this with
non-narcotic pain drugs such as ketorolac and ibuprofen that
let the patient be more alert and active soon after surgery,
and with specially developed education materials to help the
patient and his loved ones know what to expect regarding post-operative
care and at-home self care.
They then compared
these "fast-track" patients with standard care in 153
patients operated on in the year 2000 by two University of Michigan
surgeons.
The U-M team was able
to send 77 percent of patients home after one day's stay, while
maintaining a satisfaction rate of 94 percent and a post-operative
complication rate of about 5 percent, which is similar to the
rates for standard prostate surgery.
Other advantages to
the new procedure included the decreased use of narcotic pain
relievers, which in most cases were discontinued on the same
day as surgery, and increased involvement of the patient and
his spouse or family member in the post-operative period. The
two go hand in hand, as patients who are off narcotic medication
can take a more active role in caring for themselves.
"No one has looked
at how perioperative and postoperative (during and after surgery)
care can be optimized, to reduce the length of hospital stay
while maintaining patient-reported satisfaction," Sanda
explains.
"This study indicates
we can keep the patient happy and comfortable, and give him the
option of going home earlier, with a proactive, coordinated approach,"
he says.
Sanda adds that no
patient was shoved out the door just to cut the length of their
hospital stay. "Fast track" patients who elect to stay
longer are always allowed to do so."
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