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Effects of pathologic stage on the learning curve for radical prostatectomy: evidence that recurrence in organ-confined cancer is largely related to inadequate surgical technique.
Eur Urol. 2008 May; 53(5):960-6.EU

Abstract

OBJECTIVES

We previously demonstrated that there is a learning curve for open radical prostatectomy. We sought to determine whether the effects of the learning curve are modified by pathologic stage.

METHODS

The study included 7765 eligible prostate cancer patients treated with open radical prostatectomy by one of 72 surgeons. Surgeon experience was coded as the total number of radical prostatectomies conducted by the surgeon prior to a patient's surgery. Multivariable regression models of survival time were used to evaluate the association between surgeon experience and biochemical recurrence, with adjustment for PSA, stage, and grade. Analyses were conducted separately for patients with organ-confined and locally advanced disease.

RESULTS

Five-year recurrence-free probability for patients with organ-confined disease approached 100% for the most experienced surgeons. Conversely, the learning curve for patients with locally advanced disease reached a plateau at approximately 70%, suggesting that about a third of these patients cannot be cured by surgery alone.

CONCLUSIONS

Excellent rates of cancer control for patients with organ-confined disease treated by the most experienced surgeons suggest that the primary reason such patients recur is inadequate surgical technique.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. vickersa@mskcc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

18207316

Citation

Vickers, Andrew J., et al. "Effects of Pathologic Stage On the Learning Curve for Radical Prostatectomy: Evidence That Recurrence in Organ-confined Cancer Is Largely Related to Inadequate Surgical Technique." European Urology, vol. 53, no. 5, 2008, pp. 960-6.
Vickers AJ, Bianco FJ, Gonen M, et al. Effects of pathologic stage on the learning curve for radical prostatectomy: evidence that recurrence in organ-confined cancer is largely related to inadequate surgical technique. Eur Urol. 2008;53(5):960-6.
Vickers, A. J., Bianco, F. J., Gonen, M., Cronin, A. M., Eastham, J. A., Schrag, D., Klein, E. A., Reuther, A. M., Kattan, M. W., Pontes, J. E., & Scardino, P. T. (2008). Effects of pathologic stage on the learning curve for radical prostatectomy: evidence that recurrence in organ-confined cancer is largely related to inadequate surgical technique. European Urology, 53(5), 960-6. https://doi.org/10.1016/j.eururo.2008.01.005
Vickers AJ, et al. Effects of Pathologic Stage On the Learning Curve for Radical Prostatectomy: Evidence That Recurrence in Organ-confined Cancer Is Largely Related to Inadequate Surgical Technique. Eur Urol. 2008;53(5):960-6. PubMed PMID: 18207316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of pathologic stage on the learning curve for radical prostatectomy: evidence that recurrence in organ-confined cancer is largely related to inadequate surgical technique. AU - Vickers,Andrew J, AU - Bianco,Fernando J, AU - Gonen,Mithat, AU - Cronin,Angel M, AU - Eastham,James A, AU - Schrag,Deborah, AU - Klein,Eric A, AU - Reuther,Alwyn M, AU - Kattan,Michael W, AU - Pontes,J Edson, AU - Scardino,Peter T, Y1 - 2008/01/14/ PY - 2007/10/15/received PY - 2008/01/04/accepted PY - 2008/1/22/pubmed PY - 2008/9/13/medline PY - 2008/1/22/entrez SP - 960 EP - 6 JF - European urology JO - Eur Urol VL - 53 IS - 5 N2 - OBJECTIVES: We previously demonstrated that there is a learning curve for open radical prostatectomy. We sought to determine whether the effects of the learning curve are modified by pathologic stage. METHODS: The study included 7765 eligible prostate cancer patients treated with open radical prostatectomy by one of 72 surgeons. Surgeon experience was coded as the total number of radical prostatectomies conducted by the surgeon prior to a patient's surgery. Multivariable regression models of survival time were used to evaluate the association between surgeon experience and biochemical recurrence, with adjustment for PSA, stage, and grade. Analyses were conducted separately for patients with organ-confined and locally advanced disease. RESULTS: Five-year recurrence-free probability for patients with organ-confined disease approached 100% for the most experienced surgeons. Conversely, the learning curve for patients with locally advanced disease reached a plateau at approximately 70%, suggesting that about a third of these patients cannot be cured by surgery alone. CONCLUSIONS: Excellent rates of cancer control for patients with organ-confined disease treated by the most experienced surgeons suggest that the primary reason such patients recur is inadequate surgical technique. SN - 0302-2838 UR - https://www.unboundmedicine.com/medline/citation/18207316/Effects_of_pathologic_stage_on_the_learning_curve_for_radical_prostatectomy:_evidence_that_recurrence_in_organ_confined_cancer_is_largely_related_to_inadequate_surgical_technique_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(08)00005-5 DB - PRIME DP - Unbound Medicine ER -