Vickers A et al. (2007) The surgical learning curve for prostate cancer control after radical prostatectomy. J Natl Cancer Inst 99: 1171–1177

It is generally accepted that there is a learning curve associated with surgery and that more experienced surgeons achieve better outcomes; however, outcome data supporting this theory are rarely published. Vickers and colleagues carried out an investigation of the relationship between a surgeon's previous experience of performing radical prostatectomies (RPs) and biochemical recurrence of prostate cancer, which enabled them to construct a surgical learning curve.

The study included 72 surgeons and 7,765 patients with clinically localized prostate cancer who were treated with radical prostatectomy at one of four institutions between 1987 and 2003. Surgical experience was defined as the number of radical prostatectomies performed by the surgeon before the study. Serum PSA levels were measured every 3–4 months during the first postoperative year, and recurrence was defined as a PSA > 0.4 ng/ml followed by a higher PSA value. The authors created a multivariable, parametric survival-time regression model to evaluate the results.

Analysis of the learning curve showed that increasing surgical experience of up to 250 previous operations was associated with a striking improvement in cancer control, but further surgical experience had little effect on recurrence. The probability of recurrence at 5 years in patients treated by surgeons with limited experience (10 previous operations) was 17.9%, versus 10.7% in patients treated by experienced surgeons (250 previous operations).

The authors conclude that more experienced surgeons achieve better outcomes after radical prostatectomy. Further research into the specific surgical techniques associated with positive outcomes is needed.