Learning curve and stage migration of a radical retropubic prostatectomy series over a 10-y period

Prostate Cancer and Prostatic Diseases
M H Winkler, D A Gillatt

Abstract

To show the impact of learning curve and patient selection on complication rate and biochemical recurrence-free survival of a UK radical prostatectomy series for localised prostate cancer and to model the influence of common preoperative variables on biochemical recurrence after controlling for learning curve. From 1989 to 1999, 280 of 350 patients who underwent anatomical radical retropubic prostatectomy (RRP) at our institution had complete records and follow-up of at least 1 y. After exclusions of preoperative staging, factors reflecting the learning curve, early complications and prostate-specific antigen (PSA) outcome were recorded on 217 patients. Procedures before 1995 were compared with procedures after 1995. Comparison of the two groups showed a significant decrease in operating time (mean 152 vs 130 min), blood loss (mean 1500 vs 1000 ml), transfusion rate (83 vs 42%) and hospital stay (mean 7 vs 6 days). Median preoperative PSA changed significantly from 13.2 to 11.5 ng/ml. Only 17% were diagnosed by rectal examination compared to 27% in the early years. The number of clinical T1 tumours increased from 33 to 47%. This did lead to an increase of organ-confined tumours on pathological staging by 25%. Biochemical recurr...Continue Reading

References

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Citations

Mar 16, 2005·Prostate Cancer and Prostatic Diseases·F A KhanM H Winkler
Oct 10, 2007·BJU International·Francis X KeeleyJens-Uwe Stolzenburg
Feb 5, 2008·BJU International·Christopher G Eden
Sep 19, 2006·BJOG : an International Journal of Obstetrics and Gynaecology·W Y FokT K H Chung

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