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A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice.
Ann R Coll Surg Engl. 2018 Mar; 100(3):226-229.AR

Abstract

Introduction The aim of this study was to explore the impact of increasing proportions of high risk referrals on surgical margin outcomes of a surgeon's learning curve in robotic prostatectomy. Methods All patients in this study underwent robot assisted radical prostatectomy (RARP) performed by three different consultant urological surgeons. Data collected included preoperative clinical stage, Gleason score and prostate specific antigen levels, which were used to risk stratify patients according to National Institute for Health and Care Excellence criteria. Oncological clearance was assessed by overall and stage specific positive margin status. Comparisons were made between each surgeon for the first and second 50 consecutive cases. Results For the three surgeons, there was a progressive increase in the proportion of high risk cases referred accompanied by a corresponding decline in low risk disease (p<0.001). Postoperative pathology also showed an upward trend in pT3 cases across the three eras. There was no statistical difference in overall positive margin rates between the surgeons. The overall rates were 12%, 20% and 23% for the first 50 cases, and 32%, 36% and 21% for the second 50 cases for the three surgeons respectively. Conclusions Our series demonstrates an upward trend in the risk profile of men referred for robotic prostatectomy over a nine-year period. Despite this, there was minimal impact on pathological and surgical outcomes among our surgeons, who were at the initial stages of their RARP learning curve. Our results suggest that there is no requirement for an active case selection bias against patients with high risk disease for surgeons newly embarking on their RARP learning experience.

Authors+Show Affiliations

Cambridge University Hospitals NHS Foundation Trust , UK. *Contributed equally.Cambridge University Hospitals NHS Foundation Trust , UK. *Contributed equally.Cambridge University Hospitals NHS Foundation Trust , UK. *Contributed equally.Cambridge University Hospitals NHS Foundation Trust , UK.Cambridge University Hospitals NHS Foundation Trust , UK.Cambridge University Hospitals NHS Foundation Trust , UK.Cambridge University Hospitals NHS Foundation Trust , UK.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

29484935

Citation

Jaulim, A, et al. "A Comparison of Operative and Margin Outcomes From Surgeon Learning Curves in Robot Assisted Radical Prostatectomy in a Changing Referral Practice." Annals of the Royal College of Surgeons of England, vol. 100, no. 3, 2018, pp. 226-229.
Jaulim A, Srinivasan A, Hori S, et al. A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice. Ann R Coll Surg Engl. 2018;100(3):226-229.
Jaulim, A., Srinivasan, A., Hori, S., Kumar, N., Warren, A. Y., Shah, N. C., & Gnanapragasam, V. J. (2018). A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice. Annals of the Royal College of Surgeons of England, 100(3), 226-229. https://doi.org/10.1308/rcsann.2018.0001
Jaulim A, et al. A Comparison of Operative and Margin Outcomes From Surgeon Learning Curves in Robot Assisted Radical Prostatectomy in a Changing Referral Practice. Ann R Coll Surg Engl. 2018;100(3):226-229. PubMed PMID: 29484935.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice. AU - Jaulim,A, AU - Srinivasan,A, AU - Hori,S, AU - Kumar,N, AU - Warren,A Y, AU - Shah,N C, AU - Gnanapragasam,V J, Y1 - 2018/02/27/ PY - 2018/2/28/pubmed PY - 2018/3/15/medline PY - 2018/2/28/entrez KW - Early oncological outcomes KW - Learning curve KW - Robot assisted radical prostatectomy SP - 226 EP - 229 JF - Annals of the Royal College of Surgeons of England JO - Ann R Coll Surg Engl VL - 100 IS - 3 N2 - Introduction The aim of this study was to explore the impact of increasing proportions of high risk referrals on surgical margin outcomes of a surgeon's learning curve in robotic prostatectomy. Methods All patients in this study underwent robot assisted radical prostatectomy (RARP) performed by three different consultant urological surgeons. Data collected included preoperative clinical stage, Gleason score and prostate specific antigen levels, which were used to risk stratify patients according to National Institute for Health and Care Excellence criteria. Oncological clearance was assessed by overall and stage specific positive margin status. Comparisons were made between each surgeon for the first and second 50 consecutive cases. Results For the three surgeons, there was a progressive increase in the proportion of high risk cases referred accompanied by a corresponding decline in low risk disease (p<0.001). Postoperative pathology also showed an upward trend in pT3 cases across the three eras. There was no statistical difference in overall positive margin rates between the surgeons. The overall rates were 12%, 20% and 23% for the first 50 cases, and 32%, 36% and 21% for the second 50 cases for the three surgeons respectively. Conclusions Our series demonstrates an upward trend in the risk profile of men referred for robotic prostatectomy over a nine-year period. Despite this, there was minimal impact on pathological and surgical outcomes among our surgeons, who were at the initial stages of their RARP learning curve. Our results suggest that there is no requirement for an active case selection bias against patients with high risk disease for surgeons newly embarking on their RARP learning experience. SN - 1478-7083 UR - https://www.unboundmedicine.com/medline/citation/29484935/A_comparison_of_operative_and_margin_outcomes_from_surgeon_learning_curves_in_robot_assisted_radical_prostatectomy_in_a_changing_referral_practice_ L2 - http://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2018.0001?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -