1644 THE LEARNING CURVE WITH RADICAL RETROPUBIC PROSTATECTOMY: WHICH SURGICAL OUTCOMES CHANGE WITH EXPERIENCE?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111644 THE LEARNING CURVE WITH RADICAL RETROPUBIC PROSTATECTOMY: WHICH SURGICAL OUTCOMES CHANGE WITH EXPERIENCE? Anthony Corcoran and Joel Nelson Anthony CorcoranAnthony Corcoran Pittsburgh, PA More articles by this author and Joel NelsonJoel Nelson Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1753AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is evidence decreasing biochemical recurrence after radical prostatectomy (RP) is associated with the experience of the surgeon. Unfortunately, recurrence is often remote from the actual RP, and does not provide immediate information about surgical effectiveness. A large, single surgeon experience with open RP was reviewed to determine if immediately measurable outcomes change with progressive operative experience. METHODS Operative and pathologic data from 2270 consecutive RP cases from a single surgeon (JBN) were recorded in a prospective fashion from 2000–2010, and reviewed to determine if surgical experience is associated with surgical margin status, sparing of the neurovascular bundle, operative time and estimated blood loss (EBL). Spearman correlation was used to examine the correlation between EBL and consecutive case order. Chi-square test was used examine the relationship between decile of consecutive case order and category of nerve sparing or margin status. RESULTS Overall, positive surgical margins occurred in 8% of cases: 2.6% and 23.5% for pT2 and pT3, respectively. There was no correlation between consecutive case order and surgical margins status. As a continuous variable, EBL (Figure 1) was significantly (p=0.001) associated with consecutive case order (Spearman's Rho = − 0.580), dropping from a mean of 1096 mls to 326 mls for the first and last 100 cases in the series. As the decile of surgery increased (n=227 patients/decile), the proportion of patients with bilateral nerve sparing increased significantly (Figure 2, p=0.001) despite the fact the percentage of stage pT2 (75%) and pT3 (25%) cancer remained constant. There was no significant change in operative time (mean and median 145 minutes). CONCLUSIONS In a large single surgeon series, there was no significant change in margin status or operative time. Increasing experience was significantly associated with decreasing EBL and resection of nerves. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e660 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Corcoran Pittsburgh, PA More articles by this author Joel Nelson Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...