The Surgical Learning Curve for Biochemical Recurrence After Robot-assisted Radical Prostatectomy.

Male Humans Robotic Surgical Procedures / methods Robotics Retrospective Studies Learning Curve Prostatectomy / methods Prostatic Neoplasms / pathology Laparoscopy

Biochemical recurrence Learning curve Prostate cancer Radical prostatectomy Robot-assisted surgery Surgical experience

Journal

European urology oncology

ISSN: 2588-9311

Titre abrégé: Eur Urol Oncol

Pays: Netherlands

ID NLM: 101724904

Informations de publication

Date de publication:
08 2023

Historique:

received: 26 05 2022

revised: 13 06 2022

accepted: 30 06 2022

medline: 31 7 2023

pubmed: 20 7 2022

entrez: 19 7 2022

Statut: ppublish

Résumé

Improved cancer control with increasing surgical experience-the learning curve-was demonstrated for open and laparoscopic prostatectomy. In a prior single-center study, we found that this might not be the case for robot-assisted radical prostatectomy (RARP). To investigate the relationship between prior experience of a surgeon and biochemical recurrence (BCR) after RARP. We retrospectively analyzed the data of 8101 patients with prostate cancer treated with RARP by 46 surgeons at nine institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation. We evaluated the relationship of prior surgeon experience with the probability of BCR adjusting for preoperative prostate-specific antigen, pathologic stage, grade, lymph-node involvement, and year of surgery. Overall, 1047 patients had BCR. The median follow-up for patients without BCR was 33 mo (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p = 0.2). The 5-yr BCR-free survival rates for a patient treated by a surgeon with prior 10, 250, and 1000 procedures performed were, respectively, 82.0%, 82.7%, and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% [95% confidence interval: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses. These findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve. We investigated the relationship between biochemical recurrence after robot-assisted radical prostatectomy and surgeon's experience. Surgeons at an early stage of their career had similar outcomes to those of more experienced surgeons, and we hypothesized that surgical education in robotics might be an important determinant of such a finding.

Sections du résumé

BACKGROUND

OBJECTIVE

To investigate the relationship between prior experience of a surgeon and biochemical recurrence (BCR) after RARP.

DESIGN, SETTING, AND PARTICIPANTS

We retrospectively analyzed the data of 8101 patients with prostate cancer treated with RARP by 46 surgeons at nine institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We evaluated the relationship of prior surgeon experience with the probability of BCR adjusting for preoperative prostate-specific antigen, pathologic stage, grade, lymph-node involvement, and year of surgery.

RESULTS AND LIMITATIONS

Overall, 1047 patients had BCR. The median follow-up for patients without BCR was 33 mo (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p = 0.2). The 5-yr BCR-free survival rates for a patient treated by a surgeon with prior 10, 250, and 1000 procedures performed were, respectively, 82.0%, 82.7%, and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% [95% confidence interval: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses.

CONCLUSIONS

These findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve.

PATIENT SUMMARY

We investigated the relationship between biochemical recurrence after robot-assisted radical prostatectomy and surgeon's experience. Surgeons at an early stage of their career had similar outcomes to those of more experienced surgeons, and we hypothesized that surgical education in robotics might be an important determinant of such a finding.

Identifiants

DOI: 10.1016/j.euo.2022.06.010 PMID: 35850976

pubmed: 35850976

pii: S2588-9311(22)00113-4

doi: 10.1016/j.euo.2022.06.010

pii:

doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

Pagination

414-421

Subventions

Organisme : NCI NIH HHS

ID : P30 CA008748

Pays : United States