Influences of Surgical Volume on Perioperative and Oncological Outcomes Following Radical Prostatectomy

Abstract

Introduction: The purpose of this study was to evaluate whether the number of radical prostatectomies per hospital per year is associated with stage distribution, surgical techniques or quality related outcome in Germany. Materials and Methods: A German Internet-based database was analyzed. Hospitals were categorized according to their yearly radical prostatectomy (RP) volume. Patient’s characteristics, RP techniques, and outcome-related parameters were compared between the different hospital volume categories. Results: A total of 6,447 patients were analyzed. The highest rate of organ-confined disease and the lowest rate of extracapsular invasion have been demonstrated in very low-volume centres (72.6% <pT3, 27% pT ≥3). High-volume centres had the highest rate of open (92%) and robot-assisted RP approaches (5.5%). Regarding outcome, the lowest rate of positive surgical margins (11.7%) and the lowest intraoperative blood loss (3.3 g/dL) have been observed in high-volume centres. Conclusion: A higher number or RPs per year was associated with better outcome regarding quality-related parameters like surgical margin status and blood loss. However, the tumour stage distribution did not significantly differ between the low, intermediate and high-volume centres suggesting that till date the allocation of patients to the different centres is not triggered by the tumour risk classification.

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“…This is significant because comprehensive cancer centers perform higher volumes of complex cancer surgeries and have lower perioperative complications. [19][20][21] For patients, this is an incentive to receive care at a comprehensive cancer center even if it means traveling a significant distance.…”

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