Data published in April by Klein et al. have further confirmed the importance of surgical experience as it relates to outcomes of radical prostatectomy. This group has previously reported that there is a learning curve for open radical prostatectomy. In the present study they sought to discover whether the effects of the learning curve are modified by patient risk, as defined by preoperative tumor characteristics.
The study included 7,683 eligible patients with prostate cancer treated with open radical prostatectomy by a total of 72 surgeons. Surgeon experience was coded as the total prior number of radical prostatectomies done by the surgeon before a patient surgery.
There was a statistically significant association between biochemical recurrence and surgeon experience on all analyses. The absolute risk differences for patients receiving treatment from a surgeon who had carried out 10 vs 250 prior radical prostatectomies were 6.6, 12.0, and 9.7 percent in patients at low, medium, and high preoperative risk, respectively. Recurrence-free probability in patients with low risk disease approached 100 percent for the most experienced surgeons. The authors saw no evidence that patient risk affected the surgical learning curve.
They conclude as follows: “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.” The “New” Prostate Cancer InfoLink would note that these results also have highly significant implications for patients seeking the highest quality outcomes from radical prostatectomy!
Data published in April by Klein et al. have further confirmed the importance of surgical experience as it relates to outcomes of radical prostatectomy. This group has previously reported that there is a learning curve for open radical prostatectomy. In the present study they sought to discover whether the effects of the learning curve are modified by patient risk, as defined by preoperative tumor characteristics.
The study included 7,683 eligible patients with prostate cancer treated with open radical prostatectomy by a total of 72 surgeons. Surgeon experience was coded as the total prior number of radical prostatectomies done by the surgeon before a patient surgery.
There was a statistically significant association between biochemical recurrence and surgeon experience on all analyses. The absolute risk differences for patients receiving treatment from a surgeon who had carried out 10 vs 250 prior radical prostatectomies were 6.6, 12.0, and 9.7 percent in patients at low, medium, and high preoperative risk, respectively. Recurrence-free probability in patients with low risk disease approached 100 percent for the most experienced surgeons. The authors saw no evidence that patient risk affected the surgical learning curve.
They conclude as follows: “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.” The “New” Prostate Cancer InfoLink would note that these results also have highly significant implications for patients seeking the highest quality outcomes from radical prostatectomy!
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