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The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point.
J Urol. 2010 Apr; 183(4):1360-5.JU

Abstract

PURPOSE

Surgical margin status is commonly used as an end point for surgical learning. We examined the surgical margin learning curve and investigated whether surgical margins are a good marker for oncological outcome.

MATERIALS AND METHODS

The study cohort included 7,765 patients with prostate cancer treated with radical prostatectomy by 1 of 72 surgeons at a total of 4 major American academic medical centers. We calculated the learning curve for surgical margins and a concordance probability between the surgeon rates of positive surgical margins and 5-year biochemical recurrence.

RESULTS

A positive surgical margin was identified in 2,059 patients (27%). On multivariate analysis surgeon experience was strongly associated with surgical margin status (p = 0.017). The probability of a positive surgical margin was 40% for a surgeon with 10 prior cases, which decreased to 25% for a surgeon with 250 (absolute difference 15%, 95% CI 11 to 18). Learning curves differed dramatically among surgeons. For surgeon pairs the surgeon with the superior positive surgical margin rate also had the better biochemical recurrence rate only 58% of the time.

CONCLUSIONS

We noted a learning curve for surgical margins after open radical prostatectomy. The poor concordance between surgeon margin and recurrence rates suggests that while margins clearly matter and efforts should be made to decrease positive margin rates, surgical margin status is not a strong surrogate for cancer control. These results have implications for using the margin rate to evaluate changes in surgical technique and as surgeon feedback.

Authors+Show Affiliations

Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. vickersa@mskcc.orgNo 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

20171687

Citation

Vickers, Andrew, et al. "The Learning Curve for Surgical Margins After Open Radical Prostatectomy: Implications for Margin Status as an Oncological End Point." The Journal of Urology, vol. 183, no. 4, 2010, pp. 1360-5.
Vickers A, Bianco F, Cronin A, et al. The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point. J Urol. 2010;183(4):1360-5.
Vickers, A., Bianco, F., Cronin, A., Eastham, J., Klein, E., Kattan, M., & Scardino, P. (2010). The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point. The Journal of Urology, 183(4), 1360-5. https://doi.org/10.1016/j.juro.2009.12.015
Vickers A, et al. The Learning Curve for Surgical Margins After Open Radical Prostatectomy: Implications for Margin Status as an Oncological End Point. J Urol. 2010;183(4):1360-5. PubMed PMID: 20171687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point. AU - Vickers,Andrew, AU - Bianco,Fernando, AU - Cronin,Angel, AU - Eastham,James, AU - Klein,Eric, AU - Kattan,Michael, AU - Scardino,Peter, Y1 - 2010/02/19/ PY - 2009/07/17/received PY - 2010/2/23/entrez PY - 2010/2/23/pubmed PY - 2010/4/30/medline SP - 1360 EP - 5 JF - The Journal of urology JO - J. Urol. VL - 183 IS - 4 N2 - PURPOSE: Surgical margin status is commonly used as an end point for surgical learning. We examined the surgical margin learning curve and investigated whether surgical margins are a good marker for oncological outcome. MATERIALS AND METHODS: The study cohort included 7,765 patients with prostate cancer treated with radical prostatectomy by 1 of 72 surgeons at a total of 4 major American academic medical centers. We calculated the learning curve for surgical margins and a concordance probability between the surgeon rates of positive surgical margins and 5-year biochemical recurrence. RESULTS: A positive surgical margin was identified in 2,059 patients (27%). On multivariate analysis surgeon experience was strongly associated with surgical margin status (p = 0.017). The probability of a positive surgical margin was 40% for a surgeon with 10 prior cases, which decreased to 25% for a surgeon with 250 (absolute difference 15%, 95% CI 11 to 18). Learning curves differed dramatically among surgeons. For surgeon pairs the surgeon with the superior positive surgical margin rate also had the better biochemical recurrence rate only 58% of the time. CONCLUSIONS: We noted a learning curve for surgical margins after open radical prostatectomy. The poor concordance between surgeon margin and recurrence rates suggests that while margins clearly matter and efforts should be made to decrease positive margin rates, surgical margin status is not a strong surrogate for cancer control. These results have implications for using the margin rate to evaluate changes in surgical technique and as surgeon feedback. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/20171687/The_learning_curve_for_surgical_margins_after_open_radical_prostatectomy:_implications_for_margin_status_as_an_oncological_end_point_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2009.12.015?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -