Quality assurance issues in radical prostatectomy.

AIMS

Quality of surgery is a controversial issue and no studies are reporting on the standard of surgical quality in the treatment of urological cancer. The question is whether quality can be evaluated and whether there is a standard for a qualitatively well performed radical retropubic prostatectomy.

METHODS

We reviewed the literature on this topic. Data of four large studies based on Medicare claims and an EORTC report were analysed.

RESULTS

Two studies reflect hospital-volume rather than surgeon-volume. Two compared hospital-volume and surgeon-volume and in both studies there was no clear relationship between surgeon-volume and the parameters reviewed. Similarly, the EORTC study concluded that there is a variation in outcome that is not related to the caseload and proposed minimal quality standards for radical prostatectomy.

CONCLUSIONS

There is no clear relationship between surgeon-volume and surgical quality. Since radical prostatectomy is the standard treatment for the most frequent male malignancy and is offered to many patients that might never even suffer from the disease, the procedure must be performed with the highest guarantee of quality. Although, quality control of radical prostatectomy is feasible, its implementation will still require an enormous effort from the urological community.