Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;202(1):108-113.
doi: 10.1097/JU.0000000000000147. Epub 2019 Jun 7.

The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study

Carlo Andrea Bravi  1   2 , Amy Tin  2 , Emily Vertosick  2 , Elio Mazzone  1 , Alberto Martini  1 , Paolo Dell'Oglio  1 , Armando Stabile  1 , Giorgio Gandaglia  1 , Nicola Fossati  1 , Nazareno Suardi  1 , Andrea Gallina  1 , Alberto Briganti  1 , Francesco Montorsi  1 , Andrew Vickers  2
Affiliations

The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study

Carlo Andrea Bravi et al. J Urol. 2019 Jul.

Abstract

Purpose: Improved cancer control with increasing surgical experience (the learning curve) has been demonstrated for open and laparoscopic prostatectomy. We assessed the relationship between surgical experience and oncologic outcomes of robot-assisted radical prostatectomy.

Materials and methods: We analyzed the records of 1,827 patients in whom prostate cancer was treated with robot-assisted radical prostatectomy. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation. We evaluated the relationship of prior surgeon experience to the probability of positive margins and biochemical recurrence in regression models adjusting for stage, grade and prostate specific antigen.

Results: After adjusting for case mix, greater surgeon experience was associated with a lower probability of positive surgical margins (p = 0.035). The risk of positive margins decreased from 16.7% to 9.6% in patients treated by a surgeon with 10 and 250 prior procedures, respectively (risk difference 7.1%, 95% CI 1.7-12.2). In patients with nonorgan confined disease the predicted probability of positive margins was 38.4% in those treated by surgeons with 10 prior operations and 24.9% in those treated by surgeons with 250 prior operations (absolute risk reduction 13.5%, 95% CI -3.4-22.5). The relationship between surgical experience and the risk of biochemical recurrence after surgery was not significant (p = 0.8).

Conclusions: Specific techniques used by experienced surgeons which are associated with improved margin rates need further research. The impact of experience on cancer control after robotic prostatectomy differed from that in the prior literature on open and laparoscopic radical prostatectomy, and should be investigated in larger multi-institutional studies.

Keywords: learning curve; margins of excision; prostatectomy; prostatic neoplasms; robotic surgical procedures.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PSM learning curve in patients with typical cancer severity. Predicted probability of positive surgical margins (solid) and 95% CI (dash) by increasing level of surgical experience. The results are presented for the entire cohort (A) and stratified by pathologic stage (B).
Figure 2.
Figure 2.
Probability of freedom from biochemical recurrence after robotic radical prostatectomy. The data are stratified by surgeon experience (number of prior procedures) at the time of the patient’s surgery
Figure 3.
Figure 3.
Probability of freedom from biochemical recurrence after robotic prostatectomy by increasing surgical experience. Solid line: predicted probability. Dashed lines: 95% CIs
See this image and copyright information in PMC

References

    1. Abboudi H, Khan MS, Guru KA, et al. (2013) Learning curves for urological procedures: a systematic review. BJU Int 114:617–629. doi: 10.1111/bju.12315 - DOI - PubMed
    1. Hu JC, Gold KF, Pashos CL, et al. (2003) Role of Surgeon Volume in Radical Prostatectomy Outcomes. JCO 21:401–405. doi: 10.1200/JCO.2003.05.169 - DOI - PubMed
    1. Sharma N, A P, D L (2011) First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. BJU Int 1–9. doi: 10.1111/j.1464-410X.2010.09941,10500,10501.x - DOI - PubMed
    1. Yoon KJ, Koo HH (2015) Learning Curve of Robot-Assisted Laparoscopic Radical Prostatectomy for a Single Experienced Surgeon: Comparison with Simultaneous Laparoscopic Radical Prostatectomy. World J Mens Health 1–6. doi: 10.5534/wjmh.2014.33.1.30&domain=pdf&date_stamp=2015-04-23 - DOI - PMC - PubMed
    1. Jaffe J, Castellucci S, Cathelineau X, et al. (2009) Robot-Assisted Laparoscopic Prostatectomy: A Single-Institutions Learning Curve. URL 73:127–133. doi: 10.1016/j.urology.2008.08.482 - DOI - PubMed

MeSH terms