Surgical Learning Curve For Laparoscopic Radical Prostatectomy: A Retrospective Cohort Study

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Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 16 May 2009 - 10:00 PDT

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UroToday.com - In the Lancet Oncology online edition, Dr. Andrew Vickers and collaborators report that prostate cancer (CaP) recurrence is significantly reduced with increasing surgical experience among urologists performing laparoscopic radical prostatectomy (LRP). The learning curve appears greater than that for open radical prostatectomy.

In open RP analysis, the probability of a cancer recurrence decreased after 250-350 cases. In this multicenter, international retrospective cohort all patients had LRP without use of robotic assistance. A total of 4,702 patients treated between 1998 and 2007 were eligible for analysis. These patients were treated by one of 29 surgeons with < 50 total lifetime LRPs performed by 12 surgeons (41%), 50-99 by 2 surgeons (7%), 100-249 by 10 surgeons (34%), and >250 by 5 surgeons (17%). The number of prior open RPs were also counted; 0 cases in 45% of the 29 surgeons, 1-10 in 10%, 11-99 in 17%, 100-249 in 17%, and >250 in 10% of the 29 surgeons.

Stratified by urologist experience, 30% of men were seen by a surgeon who had done less than 100 previous procedures, while half were seen by a surgeon with experience of more than 250 previous procedures. There was no correlation between surgeon experience and clinical variables, except for age with more experienced surgeons seeing slightly younger patients than less experienced surgeons. A total of 402 biochemical recurrences were recorded, for a 5-year recurrence-free probability of 82%. The risk of recurrence at 5 years decreased from 17% to 16% to 9% for a patient treated by a surgeon with 10, 250 and 750 previous LRPs, respectively. The risk difference between 10 and 750 procedures was 8%. Interestingly, surgeons with prior open RP experience had worse outcomes than surgeons with no prior open RP experience. For a surgeon with 100 previous open RPs, the relative risk increased at 5 years from 7.8% to 20.1%for an absolute risk difference of 12.3%.

Vickers AJ, Savage CJ, Hruza M, Tuerk I, Koenig P, Martínez-Piñeiro L, Janetschek G, Guillonneau B
Lancet Oncol. 2009 May;10(5):475-80

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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