Radical prostatectomy: Hospital volumes and surgical volumes - does practice make perfect?

Abstract

Background: Between the years 1993 and 2003, more than 140,000 men underwent radical prostatectomy (RP), thus making RP one of the most common treatment options for localized prostate cancer in the United States.

Discussion: Localized prostate cancer treated by RP is one of the more challenging procedures performed by urologic surgeons. Studies suggest a definite learning curve in performing this procedure with optimal results noted after performing >500 RPs. But is surgical volume everything? How do hospital volumes of RP weigh in? Could fellowship training in RP reduce the critical volume needed to reach an 'experienced' level?

Summary: As we continue to glean data as to how to optimize outcomes after RP, we must not only consider surgeon and hospital volumes of RP, but also consider training of the individual surgeon.

Figure 1

Histograms juxtapose observed and expected number of surgeons' postoperative complications. More outliers on right side of histogram in observed vs. expected plot highlight providers achieving poor outcomes. On the other hand, outliers toward left in observed vs. expected plots indicate surgeons achieving more favorable outcomes (From Bianco, J Urol, 2005, copyright permission).

Figure 2

Histograms juxtapose observed and expected number of surgeons' long-term incontinence. More outliers on right side of histogram in observed vs. expected plot highlight providers achieving poor outcomes. On the contrary, outliers toward left in observed vs. expected plots indicate surgeons achieving more favorable outcomes (From Bianco, J Urol, 2005, copyright permission).