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Surgeon Experience is Strongly Associated With Biochemical Recurrence After Radical Prostatectomy for All Preoperative Risk Categories

2008; Lippincott Williams & Wilkins; Volume: 179; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2008.01.107

1527-3792

Eric A. Klein, Fernando J. Bianco, Angel M. Serio, James A. Eastham, Michael W. Kattan, J. Edson Pontes, Andrew J. Vickers, Peter T. Scardino,

Prostate Cancer Treatment and Research

No AccessJournal of UrologyAdult Urology1 Jun 2008Surgeon Experience is Strongly Associated With Biochemical Recurrence After Radical Prostatectomy for All Preoperative Risk Categories Eric A. Klein, Fernando J. Bianco, Angel M. Serio, James A. Eastham, Michael W. Kattan, J. Edson Pontes, Andrew J. Vickers, and Peter T. Scardino Eric A. KleinEric A. Klein Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , Fernando J. BiancoFernando J. Bianco Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York , Angel M. SerioAngel M. Serio Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York , James A. EasthamJames A. Eastham Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York , Michael W. KattanMichael W. Kattan Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio , J. Edson PontesJ. Edson Pontes Department of Urology, Wayne State University, Detroit, Michigan , Andrew J. VickersAndrew J. Vickers Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York , and Peter T. ScardinoPeter T. Scardino Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York View All Author Informationhttps://doi.org/10.1016/j.juro.2008.01.107AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We have previously reported that there is a learning curve for open radical prostatectomy. In the current study we determined whether the effects of the learning curve are modified by patient risk, as defined by preoperative tumor characteristics. Materials and Methods: The study included 7,683 eligible patients with prostate cancer treated with open radical prostatectomy by 1 of 72 surgeons. Surgeon experience was coded as the total prior number of radical prostatectomies done by the surgeon before a patient surgery. Multivariate survival time regression models were used to evaluate the association between surgeon experience and biochemical recurrence separately in each preoperative risk group. Results: We saw no evidence that patient risk affected the learning curve. There was a statistically significant association between biochemical recurrence and surgeon experience on all analyses. The absolute risk difference in a patient receiving treatment from a surgeon with 10 vs 250 prior radical prostatectomies was 6.6% (95% CI 3.4–10.3), 12.0% (95% CI 6.9–18.2) and 9.7% (95% CI 1.2–18.2) in patients at low, medium and high preoperative risk. Recurrence-free probability in patients with low risk disease approached 100% for the most experienced surgeons. Conclusions: 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. References 1 : Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol2003; 21: 401. Google Scholar 2 : Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol2005; 173: 2099. Link, Google Scholar 3 : Variations in morbidity after radical prostatectomy. N Engl J Med2002; 346: 1138. Crossref, Medline, Google Scholar 4 : Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg2002; 236: 583. 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Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byTaneja S (2020) Re: Influence of the Facility Caseload on the Subsequent Survival of Men with Localized Prostate Cancer Undergoing Radical ProstatectomyJournal of Urology, VOL. 204, NO. 2, (387-388), Online publication date: 1-Aug-2020.Lane B, Golan S, Eggener S, Tobert C, Kahnoski R, Kutikov A, Smaldone M, Whelan C, Shalhav A and Uzzo R (2013) Differential Use of Partial Nephrectomy for Intermediate and High Complexity Tumors May Explain Variability in Reported Utilization RatesJournal of Urology, VOL. 189, NO. 6, (2047-2053), Online publication date: 1-Jun-2013. (2012) Reply by AuthorsJournal of Urology, VOL. 188, NO. 6, (2203-2204), Online publication date: 1-Dec-2012.Elliott D (2012) Can We Better Predict and Treat Urinary Incontinence After Prostatectomy?Journal of Urology, VOL. 187, NO. 3, (789-790), Online publication date: 1-Mar-2012.Lawrentschuk N, Toi A, Lockwood G, Evans A, Finelli A, O'Malley M, Margolis M, Ghai S and Fleshner N (2009) Operator is an Independent Predictor of Detecting Prostate Cancer at Transrectal Ultrasound Guided Prostate BiopsyJournal of Urology, VOL. 182, NO. 6, (2659-2663), Online publication date: 1-Dec-2009.Moreira D, Presti J, Aronson W, Terris M, Kane C, Amling C and Freedland S (2009) Natural History of Persistently Elevated Prostate Specific Antigen After Radical Prostatectomy: Results From the SEARCH DatabaseJournal of Urology, VOL. 182, NO. 5, (2250-2256), Online publication date: 1-Nov-2009.Thompson I, Tangen C, Paradelo J, Lucia M, Miller G, Troyer D, Messing E, Forman J, Chin J, Swanson G, Canby-Hagino E and Crawford E (2009) Adjuvant Radiotherapy for Pathological T3N0M0 Prostate Cancer Significantly Reduces Risk of Metastases and Improves Survival: Long-Term Followup of a Randomized Clinical TrialJournal of Urology, VOL. 181, NO. 3, (956-962), Online publication date: 1-Mar-2009. Volume 179Issue 6June 2008Page: 2212-2217 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsoutcome assessment (health care)prostatectomyprostatic neoplasmsprostatepractice (psychology)MetricsAuthor Information Eric A. Klein Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio More articles by this author Fernando J. Bianco Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Angel M. Serio Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author James A. Eastham Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Michael W. Kattan Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author J. Edson Pontes Department of Urology, Wayne State University, Detroit, Michigan More articles by this author Andrew J. Vickers Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Peter T. Scardino Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Expand All Advertisement PDF downloadLoading ...