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.

Newer Prostate Cancer Treatment Similar to Traditional Surgery

From Washington Post.com

“This reaffirms what many other manuscripts have shown, if you go to an individual who has experience, who does this on a consistent basis, your outcomes will be better,” said Dr. Ihor S. Sawczuk, chief of urologic oncology for the Cancer Center at Hackensack University Medical Center, in New Jersey. “If you go to someone who does 20 to 50 procedures a year, that’s better than somebody who only does two to three a year.

I agree with Dr. Sawczuk, a friend and colleague, that more experienced surgeons are more likely to have better results. The surgeon is important, probably more so than the technique. I think the best way to analyze this would have been to set up a study looking at high volume robotic vs. lap vs. open surgeons and having a 3rd party analyze the results. I do not think this is something that would ever be done.

My feeling after performing many open prostate cancer surgeries, a few laparoscopic ones, and over 400 robotic ones is that robotics gives me the ability to perform more accurate surgery, and the difference is more pronounced with more difficult cases.
Being able to remove the catheter within 3 days routinely without needing X-Rays would be difficult for me to achieve with open or laparoscopic surgery.

Experience matters for prostate cancer surgery

Study tracks ‘learning curve’ in prostate surgery – CNN.com

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.

Search

+