Surgeon and hospital volume linked to radical prostatectomy outcomes

Source: MedWire News

“Briefly, higher hospital and surgeon volumes are associated with a decreased risk of most in-hospital complications after RP,” the team concludes.

They add: “These associations are statistically significant and likely to be clinically important, especially if doubling hospital or surgical volume can lead to an 8% to 9% decrease in the rate of any complication.”

Another study, this one from Canada, showing that hospital and surgeon volume are both related to lower rates of complications for prostate cancer surgery.

I am pleased to say that I am close to 500 robotic prostatectomies and my partner and I have combined for over 600.

Surgical experience affects prostate cancer control ‘regardless of risk’

From MedWire News – Oncology –

Prostate cancer control after radical prostatectomy improves with increasing surgeon experience, regardless of patients’ risk, say US scientists who suggest that the primary reason for recurrence in low-risk patients is inadequate surgical technique.
The team, led by Eric Klein from the Cleveland Clinic in Ohio, previously discovered that open radical prostatectomy has a learning curve, and other studies have indicated that patients treated by higher-volume surgeons have shorter hospital stays, fewer peri-operative complications, and better urinary continence than those treated by lower-volume surgeons.

This study was done for open radical prostatectomy patients.
My guess is that we will have similar results for robotic surgeons, but I think novice robotic surgeons that have vast experience with laparoscopic or open prostate cancer surgery will have better results than those who do not.

Experience matters for prostate cancer surgery

Study tracks ‘learning curve’ in prostate surgery –

In this study, experience was measured not by age or years as a surgeon but by the number of times doctors performed this operation.
“Advice for patients is to try to seek out experienced surgeons, and they’re likely to be ones who specialize in the procedure,” Andrew Vickers of Memorial Sloan-Kettering Cancer Center in New York City, one of the researchers, said in a telephone interview.
The researchers followed 7,765 prostate cancer patients who underwent an operation called radical prostatectomy performed by 72 surgeons at four U.S. academic medical centers in New York, Texas, Michigan and Ohio from 1987 to 2003.
As the number of times a doctor performed it increased, the number of patients who remained cancer-free five years after the surgery also rose, the researchers wrote in the Journal of the National Cancer Institute.
But at a certain point the improvement in surgical outcome topped out and stabilized regardless of how many more times a surgeon did the procedure.
“The learning curve for prostate cancer recurrence after radical prostatectomy was steep and did not start to plateau until a surgeon had completed approximately 250 prior operations,” the researchers wrote.

Surgeons should not be judged on their age or years of experience (35 years old and 8 years of experience for me), but by the number of prostates they have removed. This is one of many studies that shows better cure rates from more experienced surgeons.
This study looked at open surgeries, but I think robotics will also be similar. My personal numbers are over 500 prostatectomies of all types and over 350 robotic prostatectomies.

Surgeon influence on prostate cancer outcomes

UroToday – Prostate Cancer Surgery Outcomes: Surgeon Dependent Factors
“Subgroup analysis showed superior recurrence free survival for patients treated by surgeons with greater than 1,000 operations compared to less than 50 operations. After 250 surgeries, the curves plateau.”
This was a presentation by one of the worlds best prostate cancer surgeons, Dr. Peter Scardino.
Pertinent findings were that surgeon volume was a factor in outcomes, as was surgeon technique.
The number of cases that we do can not be changed, but technique can be improved. With robotics I think the learning curve can be somewhat quickened by reviewing surgeries on video. Ive found it helpful to review DVDs of robotic surgeries from such experts as Dr. Patel and Dr. Ahlering and review my own DVDs on cases that were difficult.
I also think it is important for surgeons to keep a database to see how they are doing and if anything can be fixed. In my robotic series, the outcomes have improved for the first 75 or so, but have been fairly stable since then over the last 100+. I think the most important reasons to have a relatively quick learning curve were my previous open prostate cancer experience of over 100 operations, as well as viewing expert video and my own video.