You have accessJournal of UrologyTechnology & Instruments: Robotics - Benign & Malignant Disease1 Apr 2014MP37-02 IMPACT OF SURGICAL VOLUME ON SURGICAL MARGIN STATUS IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL PROSTATECTOMY Giorgio Gandaglia, Firas Abdollah, Marco Bianchi, Roberto Bertini, Niccolò Maria Passoni, Ettore Di Trapani, Massimo Freschi, Roberta Lucianò, Vincenzo Mirone, Pierre I. Karakiewicz, Maxine Sun, Shahrokh F. Shariat, Francesco Montorsi, and Alberto Briganti Giorgio GandagliaGiorgio Gandaglia More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Marco BianchiMarco Bianchi More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Niccolò Maria PassoniNiccolò Maria Passoni More articles by this author , Ettore Di TrapaniEttore Di Trapani More articles by this author , Massimo FreschiMassimo Freschi More articles by this author , Roberta LucianòRoberta Lucianò More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Maxine SunMaxine Sun More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1239AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies showed a role of surgical experience on the surgical margin status in patients treated with open radical prostatectomy (ORP), where individuals treated by less experienced surgeons were at higher risk of having positive surgical margins (PSM) at final pathology. However, evidence is scarce regarding the role of surgeon experience on the surgical margin status in prostate cancer (PCa) patients receiving robot-assisted radical prostatectomy (RARP). METHODS Overall, 1,156 patients with PCa treated with RARP between February 2006 and August 2013 by four most experienced surgeons at a single tertiary referral center were identified. All patients had available preoperative and pathological data. Surgical volume was coded as the number of robotic cases done by the surgeon before the index patient’s operation. Two multivariable logistic regression models were fitted to assess the impact of surgical volume on the risk of positive surgical margins. The first model included preoperative covariates, namely clinical stage, biopsy Gleason score, and PSA at surgery. The second model included pathological data, such as pathological stage, pathological Gleason score, and nerve-sparing status. RESULTS Mean patient age was 62.5 years (median: 63). Mean surgical volume was 194 (median: 190). Overall, 178 patients (15.4%) had PSM at final pathology. When patients were categorized according to pathological stage, the rate of PSM was 9.0, 38.3, and 45.2% in patients with pT2, pT3a, and pT3b/pT4 disease, respectively (P<0.001). At multivariable analyses including preoperative patient characteristics, surgical volume continuously coded was significantly associated with a reduction in the risk of PSM, after adjusting for confounders (p=0.04). Additionally, preoperative PSA and clinical stage represented independent predictors of PSM (all P≤0.01). In multivariable analyses including pathological characteristics, surgical volume remained highly associated with decreased risk of PSM, after adjusting for confounders (P=0.01). Additionally, pathological stage and pathological Gleason score, but not nerve-sparing status, represented independent predictors of PSM (all P≤0.05). CONCLUSIONS In patients treated with RARP, surgeon experience is an independent predictor of the surgical margin status. Particularly, patients treated by more experienced surgeons are at lower risk of PSM at final pathology. These findings highlight the role of the learning curve phenomenon typical of early adopters in the context of robotic surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e392 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Giorgio Gandaglia More articles by this author Firas Abdollah More articles by this author Marco Bianchi More articles by this author Roberto Bertini More articles by this author Niccolò Maria Passoni More articles by this author Ettore Di Trapani More articles by this author Massimo Freschi More articles by this author Roberta Lucianò More articles by this author Vincenzo Mirone More articles by this author Pierre I. Karakiewicz More articles by this author Maxine Sun More articles by this author Shahrokh F. Shariat More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...