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Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories.
J Urol. 2008 Jun; 179(6):2212-6; discussion 2216-7.JU

Abstract

PURPOSE

We have previously reported that there is a learning curve for open radical prostatectomy. In the current study we determined whether the effects of the learning curve are modified by patient risk, as defined by preoperative tumor characteristics.

MATERIALS AND METHODS

The study included 7,683 eligible patients with prostate cancer treated with open radical prostatectomy by 1 of 72 surgeons. Surgeon experience was coded as the total prior number of radical prostatectomies done by the surgeon before a patient surgery. Multivariate survival time regression models were used to evaluate the association between surgeon experience and biochemical recurrence separately in each preoperative risk group.

RESULTS

We saw no evidence that patient risk affected the learning curve. There was a statistically significant association between biochemical recurrence and surgeon experience on all analyses. The absolute risk difference in a patient receiving treatment from a surgeon with 10 vs 250 prior radical prostatectomies was 6.6% (95% CI 3.4-10.3), 12.0% (95% CI 6.9-18.2) and 9.7% (95% CI 1.2-18.2) in patients at low, medium and high preoperative risk. Recurrence-free probability in patients with low risk disease approached 100% for the most experienced surgeons.

CONCLUSIONS

Cancer control after radical prostatectomy improves with increasing surgeon experience irrespective of patient risk. Excellent rates of cancer control in patients with low risk disease treated by the most experienced surgeons suggest that the primary reason that recurrence develops in such patients is inadequate surgical technique. The results have significant implications for clinical care.

Authors+Show Affiliations

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA. kleine@ccf.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

18423716

Citation

Klein, Eric A., et al. "Surgeon Experience Is Strongly Associated With Biochemical Recurrence After Radical Prostatectomy for All Preoperative Risk Categories." The Journal of Urology, vol. 179, no. 6, 2008, pp. 2212-6; discussion 2216-7.
Klein EA, Bianco FJ, Serio AM, et al. Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. J Urol. 2008;179(6):2212-6; discussion 2216-7.
Klein, E. A., Bianco, F. J., Serio, A. M., Eastham, J. A., Kattan, M. W., Pontes, J. E., Vickers, A. J., & Scardino, P. T. (2008). Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. The Journal of Urology, 179(6), 2212-6; discussion 2216-7. https://doi.org/10.1016/j.juro.2008.01.107
Klein EA, et al. Surgeon Experience Is Strongly Associated With Biochemical Recurrence After Radical Prostatectomy for All Preoperative Risk Categories. J Urol. 2008;179(6):2212-6; discussion 2216-7. PubMed PMID: 18423716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. AU - Klein,Eric A, AU - Bianco,Fernando J, AU - Serio,Angel M, AU - Eastham,James A, AU - Kattan,Michael W, AU - Pontes,J Edson, AU - Vickers,Andrew J, AU - Scardino,Peter T, Y1 - 2008/04/18/ PY - 2007/10/11/received PY - 2008/4/22/pubmed PY - 2008/6/3/medline PY - 2008/4/22/entrez SP - 2212-6; discussion 2216-7 JF - The Journal of urology JO - J Urol VL - 179 IS - 6 N2 - PURPOSE: We have previously reported that there is a learning curve for open radical prostatectomy. In the current study we determined whether the effects of the learning curve are modified by patient risk, as defined by preoperative tumor characteristics. MATERIALS AND METHODS: The study included 7,683 eligible patients with prostate cancer treated with open radical prostatectomy by 1 of 72 surgeons. Surgeon experience was coded as the total prior number of radical prostatectomies done by the surgeon before a patient surgery. Multivariate survival time regression models were used to evaluate the association between surgeon experience and biochemical recurrence separately in each preoperative risk group. RESULTS: We saw no evidence that patient risk affected the learning curve. There was a statistically significant association between biochemical recurrence and surgeon experience on all analyses. The absolute risk difference in a patient receiving treatment from a surgeon with 10 vs 250 prior radical prostatectomies was 6.6% (95% CI 3.4-10.3), 12.0% (95% CI 6.9-18.2) and 9.7% (95% CI 1.2-18.2) in patients at low, medium and high preoperative risk. Recurrence-free probability in patients with low risk disease approached 100% for the most experienced surgeons. CONCLUSIONS: Cancer control after radical prostatectomy improves with increasing surgeon experience irrespective of patient risk. Excellent rates of cancer control in patients with low risk disease treated by the most experienced surgeons suggest that the primary reason that recurrence develops in such patients is inadequate surgical technique. The results have significant implications for clinical care. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/18423716/Surgeon_experience_is_strongly_associated_with_biochemical_recurrence_after_radical_prostatectomy_for_all_preoperative_risk_categories_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2008.01.107?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -