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  3. Older men considering robotic surgery for prostate cancer shouldn’t trust th

Older men considering robotic surgery for prostate cancer shouldn’t trust th

游客2023-12-15  52
问题     Older men considering robotic surgery for prostate cancer shouldn’t trust the rosy ads promoting the expensive technology over low-tech surgery. That’s according to a new survey that found complaints about sexual problems and urinary leakage were equally common after the two procedures.
    "I wasn’t surprised at all," said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who wasn’t involved in the study. "Unfortunately, robotic prostatectomy—like many things in prostate cancer—has gotten a lot more hype than it should."
    Robotic prostatectomy has caught on rapidly in the U.S., despite the fact that there is no good evidence to show it’s better than traditional prostate removal. It is, however, much more costly, adding some $2,000 in hospital costs per procedure. The new study, published in the Journal of Clinical Oncology, is based on responses from more than 600 prostate cancer patients on Medicare, the government’s health insurance for the elderly. About 400 of them had so-called robotic-assisted laparoscopic prostatectomy, in which the surgeon uses a robot to access the prostate through multiple small holes in the belly. The rest of the patients had traditional open surgery, in which the prostate is removed through one long cut in the belly.
    Nearly nine out often men had a moderate or big problem with sexual functioning 14 months after their surgery, Dr. Michael Barry of Massachusetts General Hospital in Boston and colleagues found. And about a third of the men said they had incontinence trouble after their surgery. Overall, there were no differences between the two patient groups, although urinary problems appeared to be slightly more common after the robot procedure.
    An editorial in the journal called the findings "sobering," but added that it’s hard to compare the two procedures directly based on the new data. It’s possible, for instance, that men with high hopes for the robot procedure would be extra bothered by side effects afterward.
    "The problem that is revealed in this paper is this question of expectations," said Dr. Matthew Cooper-berg, a urologist who co-wrote the editorial. "There is a known issue of regret related to robotic surgery."
    Part of the problem is heavy promotion, he told Reuters Health, which has catapulted robot surgery to its current status. Out of the tens of thousands prostate removals done annually in the US, some 85 percent are estimated to be robotic.
    "To an extent it’s the manufacturer, to an extent it’s surgeons, to an extent it’s a culture that tends to put great faith in technology, even when the patient doesn’t understand it," said Cooper-berg, of the University of California, San Francisco.
    "The robot is impressive technology, allowing the surgeon to sit at a console and direct a camera and two or three laparoscopic arms with six degrees of wristed motion for cutting, retracting, cauterizing, or suturing—all with high magnification and three-dimensional visualization," Cooperberg and his colleagues write.
    The robots, which cost a couple of million dollars each, do have some advantages. For instance, they reduce blood loss, which helps surgeons see better when operating. But Cooperberg, who uses the technology himself, readily acknowledges that it probably doesn’t treat cancer any better than the old surgery and doesn’t have proven benefit in terms of side effects. He said patients considering surgery should look for experienced surgeons rather than focus on technology.
    "At the end of the day, these operations should only be done by surgeon who can demonstrate they have good outcomes," Cooperberg told Reuters Health. "The patients should be asking the question, ’Dr. Jones, What are your personal outcomes?’" he added. "If a surgeon can’t answer that question, I would suggest that patients look elsewhere."
    Brawley agreed. "I would not be afraid to go interview doctors," he said. "Go with your gut feeling about who you trust. Realize that every doctor you interview is going to try to make themselves look good." But he added that many people with early-stage prostate cancer might not need treatment at all.
    One study found that more than 120,000 American men diagnosed with prostate cancer every year are ideal candidates for observation, or watchful waiting. Still, the majority of them end up having surgery, radiation or other treatment instead.
    "For a man who chooses to be aggressively treated I use that study to say, you have time to sit down and rationally choose what procedure to use," Brawley told Reuters Health.
                                                    From Reuters, January 6, 2012 [br] Which of the following statements about robotic-assisted prostatectomy or its effect is TRUE?
选项 A、A robot itself did surgery on the prostate.
B、Nine men had a moderate or big problem with sexual functioning 14 months after their surgery.
C、About a third of men said they had urinary leakage trouble after their surgery.
D、Patients appeared to have urinary problems after the robotic surgery instead of traditional surgery.
答案 C
解析 本题为细节题。文章第三段中，About 400 of them had so-called robotic-assisted laparoscopic prostatectomy, in which the surgeon uses a robot to access the prostate through multiple small holes in the belly．解释了如何借助机器人完成前列腺切除手术，需要明白的是做手术的仍然是医生，而非机器人，因此选项A错误；文章第四段第一句清楚地告诉我们做完手术后14个月，10个人中大概有9个人都会有性功能的问题，这只是比率，而非确切的数字，因此选项B错误；接着文章指出大概三分之一的病人说他们接受手术后会有漏尿的问题，因此选项C正确；本段的最后一句话指出借助机器人完成手术后似乎漏尿现象更普遍，但并没有说传统的手术没有这种问题，因此选项D错误。综上所述应选择C。
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