Tag Archives: high volume surgery

Is the Complication Rate of Radical Cystectomy Predictive of the Complication Rate of Other Urological Procedures?

Source: UroToday

A higher hospital radical cystectomy volume appears to lead to a lower risk of complications only after other common urological oncological procedures, namely radical prostatectomy and nephrectomy, but not after nononcological urology procedures.

This abstract found that hospitals that performed radical cystectomy (removal of the bladder and surrounding tissue for bladder cancer) had less complcations for kidney and prostate cancer surgery as well.

I have been perfoming radical cystecomies my whole career and started perfoming these robotically 3 1/2 years ago. Although I thought performing the more complex surgery helpe me in other surgeries, I didnt realize that a study would show less complications for these other procedures.

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.