A Systematic Review of the Volume–Outcome Relationship for Radical Prostatectomy

Trinh, Quoc Dien; Bjartell, Anders; Freedland, Stephen J.; Hollenbeck, Brent K.; Hu, Jim C.; Shariat, Shahrokh F.; Sun, Maxine; Vickers, Andrew J.

doi:10.1016/j.eururo.2013.04.012

Cited by 190 publications

(139 citation statements)

References 86 publications

(124 reference statements)

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…In addition, most observational studies generally include men treated at high-volume tertiary referral centers. Since surgeon, radiotherapist, and oncology expertise, as well as hospital case volumes, affect treatment-related outcomes [18][19][20][21], results obtained in this setting might not be applicable to the general population. Unlike the majority of cancer data sets from large, highly specialized, singlecenter academic or tertiary referral institutions in the USA and Europe, registries reflect outcomes in men with PCa treated in real-world community settings.…”

Section: A Role For Pca Registriesmentioning

confidence: 99%

Prostate Cancer Registries: Current Status and Future Directions

Gandaglia¹,

Bray

Cooperberg

et al. 2016

European Urology

View full text Add to dashboard Cite

Context: Disease-specific registries that enroll a considerable number of patients play a major role in prostate cancer (PCa) research. Objective: To evaluate available registries, describe their strengths and limitations, and discuss the potential future role of PCa registries in outcomes research. Evidence acquisition: We performed a literature review of the Medline, Embase, and Web of Science databases. The search strategy included the terms prostate cancer, outcomes, statistical approaches, population-based cohorts, registries of outcomes, and epidemiological studies, alone or in combination. We limited our search to studies published between January 2005 and January 2015. Evidence synthesis: Several population-based and prospective disease-specific registries are currently available for prostate cancer. Studies performed using these data sources provide important information on incidence and mortality, disease characteristics at presentation, risk factors, trends in utilization of health care services, disparities in access to treatment, quality of care, long-term oncologic and health-related quality of life outcomes, and costs associated with management of the disease. Although data from these registries have some limitations, statistical methods are available that can address certain biases and increase the internal and external validity of such analyses. In the future, improvements in data quality, collection of tissue samples, and the availability of data feedback to health care providers will increase the relevance of studies built on population-based and disease-specific registries. Conclusions: The strengths and limitations of PCa registries should be carefully considered when planning studies using these databases. Although randomized controlled trials still provide the highest level of evidence, large registries play an important and growing role in advancing PCa research and care. Patient summary: Several population-based and prospective disease-specific registries for prostate cancer are currently available. Analyses of data from these registries yield information that is clinically relevant for the management of patients with prostate cancer.

show abstract

Section: A Role For Pca Registriesmentioning

confidence: 99%

Prostate Cancer Registries: Current Status and Future Directions

Gandaglia¹,

Bray

Cooperberg

et al. 2016

European Urology

View full text Add to dashboard Cite

show abstract

“…[1][2][3] Several studies have demonstrated a relationship between surgeon experience and outcomes in minimally-invasive prostate surgery. 4,5 Discrepancies in patient outcomes also lie in the hospital characteristics, with high-volume and teaching hospitals providing better quality care. 6,7 An integral aspect of surgical care in teaching hospitals is resident involvement.…”

Section: Introductionmentioning

confidence: 99%

The impact of resident involvement in minimally-invasive urologic oncology procedures

Ruhotina¹,

Dagenais²,

Gandaglia³

et al. 2014

CUAJ

Self Cite

View full text Add to dashboard Cite

Introduction: Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database. Methods: Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005Files ( -2011, we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates. Results: A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic). Conclusions:Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.

show abstract

“…This practice may reflect the US trends in expectant management utilization for prostate cancer ongoing centralization of American health care, with fewer RPs being performed on average at low-volume hospitals. 28,29 Urologists at these low-volume hospitals may prefer nonoperative management to RP.…”

Section: Discussionmentioning

confidence: 99%

American trends in expectant management utilization for prostate cancer from 2000 to 2009

Maurice

Abouassaly

Zhu

2014

CUAJ

View full text Add to dashboard Cite

Introduction: The overtreatment of early prostate cancer has become a major public health concern. Expectant management (EM) is a strategy to minimize overtreatment, but little is known about its pattern of use. We sought to examine national EM utilization over the preceding decade. Methods: We examined prostate cancer treatment utilization from 2000 to 2009 using the National Cancer Database. EM use was analyzed in relation to other treatments and by cancer stage, age group, Charlson score, and hospital practice setting. Results: Overall, 109 997 (8.2%) men were managed initially with EM. EM usage remained stable at 7.6% to 9.5% from 2000 to 2009 with no appreciable increase for low-stage cancers. Usage was only slightly higher in elderly patients and in patients with multiple comorbidities. Veterans Affairs and low-volume hospitals had a much higher and increasing EM rate (range: 18.8%-29.8% and 15.1%-24.2%, respectively), compared to community hospitals, comprehensive cancer centres, and teaching hospitals, which showed no increased adoption. On further analysis, EM use remained high for low-stage cancers at Veterans Affairs and lowvolume hospitals (24.0% and 19.1%, respectively), regardless of age or comorbidity, a pattern not shared by other practice settings. Conclusions: EM utilization remained low and stable last decade, regardless of disease or patient characteristics. Conversely, Veterans Affairs and low-volume hospitals led the trend in national EM adoption, particularly in men with low-stage cancers and limited life expectancies. The limitations of this dataset preclude any determination of the appropriateness of EM utilization. Nonetheless, further study is needed to identify factors influencing EM adoption to ensure its proper use in the future.

show abstract

A Systematic Review of the Volume–Outcome Relationship for Radical Prostatectomy

Cited by 190 publications

References 86 publications

Prostate Cancer Registries: Current Status and Future Directions

Prostate Cancer Registries: Current Status and Future Directions

The impact of resident involvement in minimally-invasive urologic oncology procedures

American trends in expectant management utilization for prostate cancer from 2000 to 2009

Contact Info

Product

Resources

About