Death rate during robotic prostatectomy surgery?

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dmm1987
New Member


Date Joined Sep 2013
Total Posts : 2
   Posted 9/26/2013 9:01 PM (GMT -6)   
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.

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 9/26/2013 9:11 PM (GMT -6)   
very slim chances of dying during the surgery.

But I'm sure seeing you before going under will be good for both of you. Best of luck.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2331
   Posted 9/26/2013 9:15 PM (GMT -6)   
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)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24302
   Posted 9/26/2013 9:20 PM (GMT -6)   
How old is your father for starters?

Death from either robotic or open prostate surgery is extremely rare, that would be far removed from my mind.

David
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
Open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incontinence & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA: Too High
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries 2009-2012

dmm1987
New Member


Date Joined Sep 2013
Total Posts : 2
   Posted 9/26/2013 9:26 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.

azsunshine2013
Regular Member


Date Joined Aug 2013
Total Posts : 83
   Posted 9/26/2013 10:41 PM (GMT -6)   
My mom had a hysterectomy when I was 22 years old. She was worried that she would die and gave my sisters and I a special gift. She didn't die and that was 38 years ago. Then about 8 years ago, she had a hip replacement and thought the same thing and gave us each a piece of her jewelry. She's still with us.

I think when we are facing surgery, we all come a little closer to our mortality. There is alway a chance (but not probable) that one won't make it through surgery regardless of the degree of seriousness.

So take a deep breath and spend some time together making memories and acknowledge how he feels but know it most likely happen.

Best of luck to your father and you! He's lucky to have a daughter that loves him so much.
Husband (age 62): Da Vinci on May 9, 2013
Gleason: 3+3
14 core biopsy: 1 small spot of cancer found on one core.
Pathology good: cancer contained in the prostate, Gleason did not change.
3 month PSA: <.1

I am not a member of the medical industry and anything I say is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5921
   Posted 9/26/2013 11:07 PM (GMT -6)   
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.
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 6-mo injection 9/12;Prolia 6-mo inj 12/12, 06/13

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24302
   Posted 9/26/2013 11:11 PM (GMT -6)   
With your father being 60, and assuming his general health beyond PC is fairly good, he should do fine with surgery. Sounds like they are attacking his aggressive cancer correctly, with first HT, now surgery, then later radiation. That's throwing the entire arsenal at it, which is a good protocol for a Gleason 9.

Hope he does well ahead, with the surgery, and beyond.

We are here for you, and for him.

David
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
Open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incontinence & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA: Too High
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries 2009-2012

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 3140
   Posted 9/27/2013 12:02 AM (GMT -6)   
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
I'll be in the shop.
Age 53
PSA 4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13
GS 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 1741
   Posted 9/27/2013 8:58 AM (GMT -6)   
The real question is why surgery with a G9? Often this has to be followed by radiation. That doubles the risk and side effects. My docs would not operate due to my risk profile and did not want to subject me to both surgery and radiation. Get multiple opinions and include a medical oncologist because a G9 is very high risk cancer.

Best wishes
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 and Testosterone less than 3 since February 2011

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7701
   Posted 9/27/2013 12:46 PM (GMT -6)   
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
Advanced Prostate Cancer Survivor
Patient Advocate and Support Group Leader

Not a medical professional!!!

Post Edited (TC-LasVegas) : 9/27/2013 11:50:51 AM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3734
   Posted 9/27/2013 3:26 PM (GMT -6)   
The published numbers from Medicare is 1% within 30 days of surgery. The generally accepted number is .5% of radical prostate surgeries result in death on the operating table. Death can arise from cardiac conditions, infections and more rare, loss of blood. Death would be rare in a healthily individual.
68 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 4 years of psa's all at 0.1.

FrackMe
Regular Member


Date Joined Jun 2011
Total Posts : 348
   Posted 9/27/2013 3:36 PM (GMT -6)   
The statistical chance of dying from the surgery is far less than dying from PCa.

lapilot
Regular Member


Date Joined Nov 2012
Total Posts : 327
   Posted 9/27/2013 5:35 PM (GMT -6)   
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.

njs
Regular Member


Date Joined Jun 2013
Total Posts : 280
   Posted 9/27/2013 5:51 PM (GMT -6)   
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.
Jan '13: PSA 1.23, small nodule on DRE (1st screening @ age 40)
Mar '13: Biopsy 2 of 12 cores GS 3+3: rt mid 10% and rt apex 20% w/ PNI+ Stage cT2a
Apr '13: Biopsy confirmed by Dr. Epstein @ Hopkins
May '13: open RRP by Dr. Burnett @ Hopkins. Both nerves spared.
Final Path: GS 3+3, organ confined (tumor extent moderate), SV and 11 nodes all negative (pT2a), negative margins!
PSA: 0.01 @ 6 wks

lapilot
Regular Member


Date Joined Nov 2012
Total Posts : 327
   Posted 9/28/2013 12:10 PM (GMT -6)   
njs,

The paper, 'Perioperative Outcomes for Laparoscopic and Robotic Comparied with open Prostatectomy Using the National Surgical Quality Improvement Program (NSQIP) Databe"

http://www.ncbi.nlm.nih.gov/pubmed/23876584

When I talked with several doctors, they said that most of these were probably due to patients with several comorbidity such as age, diabetes, heart or vascular diseases, etc.

Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 197
   Posted 9/28/2013 12:42 PM (GMT -6)   
If the duration of your visit is limited, you can be of the most help by being there in person following the surgery.
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