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The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study.
J Urol. 2019 07; 202(1):108-113.JU

Abstract

PURPOSE

Improved cancer control with increasing surgical experience (the learning curve) has been demonstrated for open and laparoscopic prostatectomy. We assessed the relationship between surgical experience and oncologic outcomes of robot-assisted radical prostatectomy.

MATERIALS AND METHODS

We analyzed the records of 1,827 patients in whom prostate cancer was treated with robot-assisted radical prostatectomy. 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 to the probability of positive margins and biochemical recurrence in regression models adjusting for stage, grade and prostate specific antigen.

RESULTS

After adjusting for case mix, greater surgeon experience was associated with a lower probability of positive surgical margins (p = 0.035). The risk of positive margins decreased from 16.7% to 9.6% in patients treated by a surgeon with 10 and 250 prior procedures, respectively (risk difference 7.1%, 95% CI 1.7-12.2). In patients with nonorgan confined disease the predicted probability of positive margins was 38.4% in those treated by surgeons with 10 prior operations and 24.9% in those treated by surgeons with 250 prior operations (absolute risk reduction 13.5%, 95% CI -3.4-22.5). The relationship between surgical experience and the risk of biochemical recurrence after surgery was not significant (p = 0.8).

CONCLUSIONS

Specific techniques used by experienced surgeons which are associated with improved margin rates need further research. The impact of experience on cancer control after robotic prostatectomy differed from that in the prior literature on open and laparoscopic radical prostatectomy, and should be investigated in larger multi-institutional studies.

Authors+Show Affiliations

Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , New York , New York.Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , New York , New York.Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , New York , New York.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Unit of Urology, Division of Oncology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele , Milan , Italy.Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , New York , New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30747873

Citation

Bravi, Carlo Andrea, et al. "The Impact of Experience On the Risk of Surgical Margins and Biochemical Recurrence After Robot-Assisted Radical Prostatectomy: a Learning Curve Study." The Journal of Urology, vol. 202, no. 1, 2019, pp. 108-113.
Bravi CA, Tin A, Vertosick E, et al. The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study. J Urol. 2019;202(1):108-113.
Bravi, C. A., Tin, A., Vertosick, E., Mazzone, E., Martini, A., Dell'Oglio, P., Stabile, A., Gandaglia, G., Fossati, N., Suardi, N., Gallina, A., Briganti, A., Montorsi, F., & Vickers, A. (2019). The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study. The Journal of Urology, 202(1), 108-113. https://doi.org/10.1097/JU.0000000000000147
Bravi CA, et al. The Impact of Experience On the Risk of Surgical Margins and Biochemical Recurrence After Robot-Assisted Radical Prostatectomy: a Learning Curve Study. J Urol. 2019;202(1):108-113. PubMed PMID: 30747873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study. AU - Bravi,Carlo Andrea, AU - Tin,Amy, AU - Vertosick,Emily, AU - Mazzone,Elio, AU - Martini,Alberto, AU - Dell'Oglio,Paolo, AU - Stabile,Armando, AU - Gandaglia,Giorgio, AU - Fossati,Nicola, AU - Suardi,Nazareno, AU - Gallina,Andrea, AU - Briganti,Alberto, AU - Montorsi,Francesco, AU - Vickers,Andrew, Y1 - 2019/06/07/ PY - 2019/2/13/pubmed PY - 2019/6/19/medline PY - 2019/2/13/entrez KW - learning curve KW - margins of excision KW - prostatectomy KW - prostatic neoplasms KW - robotic surgical procedures SP - 108 EP - 113 JF - The Journal of urology JO - J. Urol. VL - 202 IS - 1 N2 - PURPOSE: Improved cancer control with increasing surgical experience (the learning curve) has been demonstrated for open and laparoscopic prostatectomy. We assessed the relationship between surgical experience and oncologic outcomes of robot-assisted radical prostatectomy. MATERIALS AND METHODS: We analyzed the records of 1,827 patients in whom prostate cancer was treated with robot-assisted radical prostatectomy. 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 to the probability of positive margins and biochemical recurrence in regression models adjusting for stage, grade and prostate specific antigen. RESULTS: After adjusting for case mix, greater surgeon experience was associated with a lower probability of positive surgical margins (p = 0.035). The risk of positive margins decreased from 16.7% to 9.6% in patients treated by a surgeon with 10 and 250 prior procedures, respectively (risk difference 7.1%, 95% CI 1.7-12.2). In patients with nonorgan confined disease the predicted probability of positive margins was 38.4% in those treated by surgeons with 10 prior operations and 24.9% in those treated by surgeons with 250 prior operations (absolute risk reduction 13.5%, 95% CI -3.4-22.5). The relationship between surgical experience and the risk of biochemical recurrence after surgery was not significant (p = 0.8). CONCLUSIONS: Specific techniques used by experienced surgeons which are associated with improved margin rates need further research. The impact of experience on cancer control after robotic prostatectomy differed from that in the prior literature on open and laparoscopic radical prostatectomy, and should be investigated in larger multi-institutional studies. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/30747873/The_Impact_of_Experience_on_the_Risk_of_Surgical_Margins_and_Biochemical_Recurrence_after_Robot_Assisted_Radical_Prostatectomy:_A_Learning_Curve_Study_ L2 - https://www.jurology.com/doi/10.1097/JU.0000000000000147?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -