Death rate during robotic prostatectomy surgery?

My father was diagnosed with prostate cancer and he has a gleason score of 9 (4+5). Right now the doctor says it is only in his prostate so they want to do what I believe is called the "da vinci" surgery? Anyways, my father and I have planned on me coming to visit him (I live 2000 miles away) after the surgery to help out around the house and take care of him after the surgery. Tonight while talking to him, he asked me to come before the surgery to see me and by the tone of his voice it was obvious that it was because he was thinking about the possibility of dying while having the surgery and us never getting to see each other again. I have since tried to locate information about how dangerous this surgery is but cant find any information. I am worried out of my mind that I may lose my father in less than 2 months. If anyone can help me, I thank you in advance and may God bless you all.

Thank you.

In three years of participation here on the forum, I've never actually heard of anyone dying during the surgery, though at various times I've seen figures of one in 100 or one in 200.  I've always questioned those numbers.

But, the question is, what shape were those men in at the time of the surgery?  Perhaps they were not very good candidates for major surgery.  What's your father's general health?  Like everyone else I know who has had surgery via the DaVinci robotic machine, I had to undergo some pretty extensive health checks at age 65 before my doctor would sign off on the surgery.  For me, that included a complete blood panel, and even a nuclear stress test and a visit to a cardiologist.

Others more knowledgeable than I might question the wisdom of surgery in the case of a Gleason 4 + 5.  Radiation coupled with hormone therapy might be a wiser choice for such an aggressive cancer, and I'm not sure how the doctor can say with confidence that it hasn't already escaped the prostate capsule, in which case, the value of surgery would be especially questionable.

Right now, your father is undoubtedly going through a lot of mental turmoil, and it's not unrealistic to imagine that he's thinking about the end of life, but hopefully you'll both have each other's company for years to come.  Good luck to both of you.

 

Post Edited (clocknut) : 9/26/2013 8:18:24 PM (GMT-6)

Thank you all for your replies, information and well wishes. I appreciate such a hasty response. My father is 60 years old and I would say his heath is probably pretty average for a 60 year old man. My father has been on hormone therapy for almost 1 year now and the surgeon doing the surgery has said he would like to do radiation after he has healed from surgery because of how aggressive the cancer is.

I have to be honest and say I am not sure what the prostate capsule is, but my father has had MRI/CT scans (dont know if those are the same thing?) and I guess they have done tests to see if the cancer has metastasized and the doctor says it has not. I know surgery wouldnt do much good if its gone beyond the prostate..so I am praying that even though it is so aggressive, that it is in fact still in the prostate only.

There is a risk of death every day. It is ever so slightly increased by undergoing surgery, but also by walking across a street in any major city.

The numbers quoted to me were less than a percent.

The risk of a long and painful death at the end of a few years of untreated PCa scared me more.

Welcome to HW. He'll be fine. There is a risk for all surgeries but it so small it's not really worth talking about.

Keep us updated on progress and we're here if you have questions.
Andrew

The death rate reported by JAMA, and NEJM for RP is 1 in 200. But there are lots of asterisks to note including the following:

1> Surgeons with higher volume of annual RP's have lower surgery related mortality rates.
2> Younger patients have lower surgery related mortality rates. (Under the median of 63yo)
3> Patients with few non-prostate cancer related morbidities such as diabetes, COPD, heart issues, high blood pressure, etc. have fewer surgery related mortality rates.
4> High volume RP institutions such as universities have fewer surgery related mortality rates.


It's very possible to stack the odds in one's favor considering the above criteria. I had a surgeon who has performed around 2500 RP's in the past 12 years. which means he does mostly RP's and has a very experienced team. I was young at 44 and I was otherwise healthy. The center I used was the City of Hope which is in the top twenty in the US and the doctor well regarded. I would think that 1 in 2500, and even much better, was more statistically correct for my experience.

The mortality rate for my advanced dx was probably 1 in 5 over ten years.

The odds were heavily in my favor.

Tony

The statistical chance of dying from the surgery is far less than dying from PCa.

lapilot said...
I just looked at a new published paper that of 5319 radical prostatectomies RP (4036 marginally invasive RP, and 1283 open RP.) Data was compiled from the National Surgical Quality Improvement Program NSQIP database.

Mortality from MIRP was 0.05% and open RP was 0.4%, which was eight times higher.

I haven't seen that paper, but a potential pitfall is to draw conclusions about fundamental advantage of robotic over open from results that were gathered across multiple disparate institutions. Better to compare results from the same institution that still does a lot of both.

Here, for instance, is a recent study from Hopkins discussing changes in length-of-stay over the last 20 years that concludes that "RALRP appears to result in a higher proportion of 'off-pathway' [greater than 3 day stay] patients, primarily due to ileus, compared with RRP and LRP"

Robotic requires general anesthesia (which is the source of most of the risk of serious intra- and peri-operative complications) whereas open RRP can be done under regional anesthesia. Robotic surgery also violates the peritoneal cavity.

If the duration of your visit is limited, you can be of the most help by being there in person following the surgery.