The Learning Curve for Laparoscopic Radical Prostatectomy: An International Multicenter Study

Abstract

Purpose It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy. Materials and Methods We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation. Results Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve. Conclusions The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience.

Long‐term oncological and continence outcomes after laparoscopic radical prostatectomy: a single‐centre experience

“…Secin et al . [ 13 ] , in their large international multicentre study of 8544 LRP cases, primarily investigating learning curves, reported an overall PSM rate of 22%. The authors highlighted the well-known problem of a prolonged learning curve in LRP, plateauing at ∼ 200 -250 cases.…”

“…The authors highlighted the well-known problem of a prolonged learning curve in LRP, plateauing at ∼ 200 -250 cases. BCR-free survival rates were not investigated owing to a lack of follow-up data [ 13 ] . Although the authors primarily looked at learning curves, the PSM rate seems fairly low; however, owing to the fact that after 200 cases a plateau was achieved and the overall number of patients included in this study was remarkable, higher PSM rates produced during the learning curve did not negatively impact the overall PSM rate of the entire cohort.…”

Robot-assisted radical prostatectomy: Another Canadian experience

“…Ideally, 1-and 3-month continence outcomes (strict pad-free definition) should have also been reported as earlier recovery has been demonstrated in several reports. 2,6 Interestingly, pT2-PSM rates (22% vs. 17%) appear moderately high when compared to high volume surgeons (4%-16%).…”

“…Ideally, 1-and 3-month continence outcomes (strict pad-free definition) should have also been reported as earlier recovery has been demonstrated in several reports. 2,6 Interestingly, pT2-PSM rates (22% vs. 17%) appear moderately high when compared to high volume surgeons (4%-16%). 2,7 Similarly, there is a concern for the lymph node yield for both ORP (5.4) and RARP (3.9) groups when compared to contemporary reported series, 8 Robot-assisted radical prostatectomy: Another Canadian experience robot-assisted radical prostatectomy extended pelvic lymph node dissection is recommended.…”

Radiotherapy after radical prostatectomy: when and for whom?

“…В мульти-центрическом исследовании Secin et al [9] показано, что количество радикальных про-статэктомий, выполненных с «чистым» хи-рургическим краем, постепенно возрастает по мере увеличения личного опыта хирурга, хотя авторы при этом настаивают, что про-фессионализм не есть простое накопление количества произведённых операций. Даже опытный хирург может постоянно повторять одну и ту же интраоперационную техническую ошибку, не улучшая тем самым результаты сво-их оперативных вмешательств.…”