Effects of pathologic stage on the learning curve for radical prostatectomy: evidence that recurrence in organ-confined cancer is largely related to inadequate surgical technique.

European Urology
Andrew J VickersPeter T Scardino

Abstract

We previously demonstrated that there is a learning curve for open radical prostatectomy. We sought to determine whether the effects of the learning curve are modified by pathologic stage. The study included 7765 eligible prostate cancer patients treated with open radical prostatectomy by one of 72 surgeons. Surgeon experience was coded as the total number of radical prostatectomies conducted by the surgeon prior to a patient's surgery. Multivariable regression models of survival time were used to evaluate the association between surgeon experience and biochemical recurrence, with adjustment for PSA, stage, and grade. Analyses were conducted separately for patients with organ-confined and locally advanced disease. Five-year recurrence-free probability for patients with organ-confined disease approached 100% for the most experienced surgeons. Conversely, the learning curve for patients with locally advanced disease reached a plateau at approximately 70%, suggesting that about a third of these patients cannot be cured by surgery alone. Excellent rates of cancer control for patients with organ-confined disease treated by the most experienced surgeons suggest that the primary reason such patients recur is inadequate surgical techni...Continue Reading

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Citations

Jul 27, 2007·Der Urologe. Ausg. A·R Harzmann
Apr 2, 2010·World Journal of Urology·Elmar HeinrichLutz Trojan
Sep 4, 2008·Current Urology Reports·Fernando J Bianco
Aug 30, 2008·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Glenn Isaacson
Dec 24, 2010·Nature Reviews. Clinical Oncology·John ThomsRobert G Bristow
Jun 6, 2009·Nature Reviews. Urology·Andrew J Vickers, Hans Lilja
Jun 2, 2010·Prostate Cancer and Prostatic Diseases·A A CaireJ W Moul
Jun 4, 2010·Academic Medicine : Journal of the Association of American Medical Colleges·Fernando J BiancoAndrew J Vickers
Sep 4, 2010·BMC Research Notes·Andrew J Vickers, Angel M Cronin
Jun 16, 2011·Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada·Nathan LawrentschukNeil E Fleshner
Aug 22, 2014·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Behfar EhdaieDavid Amar
Oct 19, 2010·The Journal of Urology·Fernando P SecinBertrand Guillonneau
Feb 23, 2010·The Journal of Urology·Andrew J VickersJames A Eastham
Mar 12, 2010·Urologic Oncology·Neil E FleshnerAlexandre Zlotta
Dec 29, 2009·European Urology·Declan G MurphyHenk van der Poel
Jan 20, 2010·The Journal of Urology·Fernando J BiancoPeter T Scardino
Oct 20, 2009·The Journal of Urology·Caroline J Savage, Andrew J Vickers
Mar 17, 2009·Surgical Oncology·A Mitra, V Khoo
Feb 24, 2009·European Urology·Manfred P Wirth, Oliver W Hakenberg
May 5, 2012·The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS·Thierry LebeauChristophe Vaessen

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