Given the technical challenges that radical prostatectomy presents for surgeons, an investigation of the effect of surgeon experience on outcomes is crucial, particularly given that the choice of surgeon may be the only factor affecting the outcome that the patient can control. Writing in the Journal of Urology, a group of researchers report their results after investigating whether more experienced surgeons achieved better results, regardless of patient risk group or whether the association between surgeon and risk group was found only in certain subgroups of patients, such as those at highest risk of failure.
The authors report the results of 7683 patients who underwent radical prostatectomy from January 1987 through December 2003 by 1 of the 72 surgeons at the following institutions: Memorial Sloan-Kettering Cancer Center; Baylor College of Medicine; Wayne State University; and, The Cleveland Clinic. All study procedures were carried out only at the institutions while the surgeons were on staff there. Surgeon experience was based on the number of radical prostatectomy procedures performed by the surgeon before the patient operation, regardless of where the procedure was performed or whether the previous patients were eligible for the current analysis. Overall, the investigators found a clear association between cancer control after radical prostatectomy and increasing surgeon experience regardless of the patient's preoperative risk group (that is, low risk, intermediate risk, or high risk). Specifically, the absolute risk difference for those treated by a surgeon who had performed 10 versus 250 procedures was 6.6, 12.0 and 9.7%, respectively, for those in the preoperative low-, intermediate-, and high-risk groups. Remarkably, the results demonstrated a recurrence-free probability approaching 100% for patients in the low-risk group who were treated by the most experienced surgeons. This finding also indicates that recurrence in this group primarily is the result of surgical technique. The authors conclude that changes in surgical education are required and that research is needed to identify the specific aspects of the radical prostatectomy procedure that affect cancer control, because the learning curve for this procedure clearly affects all patients regardless of preoperative risk group.
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