Van Poppel H, Boulanger S F F, Joniau S
Department of Urology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Eur J Surg Oncol. 2005 Aug;31(6):650-5. doi: 10.1016/j.ejso.2005.02.017. Epub 2005 Apr 15.
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.
We reviewed the literature on this topic. Data of four large studies based on Medicare claims and an EORTC report were analysed.
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.
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.
手术质量是一个有争议的问题，目前尚无关于泌尿外科癌症治疗中手术质量标准的研究报道。问题在于手术质量能否被评估，以及对于高质量完成的耻骨后根治性前列腺切除术是否存在一个标准。
我们回顾了关于该主题的文献。分析了四项基于医疗保险索赔的大型研究数据以及一份欧洲癌症研究与治疗组织（EORTC）的报告。
两项研究反映的是医院手术量而非外科医生手术量。两项研究对医院手术量和外科医生手术量进行了比较，且在这两项研究中，外科医生手术量与所审查的参数之间均无明确关联。同样，EORTC研究得出结论，结果存在差异，且与病例数量无关，并提出了根治性前列腺切除术的最低质量标准。
外科医生手术量与手术质量之间没有明确的关联。由于根治性前列腺切除术是男性最常见恶性肿瘤的标准治疗方法，且许多可能从未患该病的患者也接受了该手术，因此该手术必须在最高质量保证下进行。虽然，根治性前列腺切除术的质量控制是可行的，但其实施仍需要泌尿外科界付出巨大努力。
