Department of Urology, Arizona Urology Specialists, Phoenix, Arizona 85013, USA.
J Endourol. 2010 Mar;24(3):473-7. doi: 10.1089/end.2009.0121.
The use of robot-assisted laparoscopic radical prostatectomy (RALP) is widespread in the community. A definitive RALP "learning curve" has not been defined and existing learning curves do not account for urologists without prior advanced laparoscopic skills. Therefore, an easily evaluable metric, the "oncological experience curve," would be clinically useful to all urologists performing RALP. Positive surgical margin (PSM) status for all subjects undergoing RALP during the first 4 years of a single surgeon's experience was assessed. Univariate and multivariate analyses and logistic regression identified predictors of PSM creation and their correlation with surgeon case volume. The oncological experience curve was defined as the case point at which only pT2 stage, not surgeon volume (and thus surgeon inexperience), predicted PSM in the logistic regression. A total of 469 consecutive subjects comprised our cohort. Overall pT2 and pT3 PSM rates were 20% and 40%, respectively. Preoperative prostate-specific antigen, pathologic stage, and year of surgery were associated with PSM occurrence. Pathologic stage exclusively correlated to PSM in pT2 specimens for the first time during the fourth year, after 290 subjects had been treated. pT2 PSM rate before and after Case 290 was 25% and 10%, respectively (p < 0.001). The oncological experience curve is a clinically meaningful measure to evaluate the RALP learning curve for non-fellowship-trained urologists. The oncological experience curve may be much longer than the previously reported learning curves. Surgeons should consider whether they can build enough experience to minimize suboptimal oncological outcomes before embarking on or continuing a RALP program.
机器人辅助腹腔镜前列腺根治术（RALP）在临床上得到了广泛应用。目前尚未确定明确的 RALP“学习曲线”，并且现有的学习曲线并未考虑到没有先前先进腹腔镜技能的泌尿科医生。因此，对于所有进行 RALP 的泌尿科医生来说，一种易于评估的指标，即“肿瘤学经验曲线”，将具有临床实用价值。评估了在一名外科医生经验的前 4 年内接受 RALP 的所有患者的阳性切缘（PSM）状态。单变量和多变量分析以及逻辑回归确定了 PSM 形成的预测因素及其与外科医生手术量的相关性。肿瘤学经验曲线定义为只有 pT2 期而不是外科医生的手术量（因此外科医生经验不足）可以预测逻辑回归中 PSM 的病例点。总共 469 例连续患者组成了我们的队列。总体上 pT2 和 pT3 的 PSM 发生率分别为 20％和 40％。术前前列腺特异性抗原、病理分期和手术年份与 PSM 的发生有关。病理分期仅与第四年的第 290 例患者治疗后的前 290 例患者的 pT2 标本中的 PSM 相关。在第 290 例患者之前和之后，pT2 PSM 发生率分别为 25％和 10％（p <0.001）。肿瘤学经验曲线是一种评估非 fellowship 培训泌尿科医生 RALP 学习曲线的有意义的指标。肿瘤学经验曲线可能比以前报道的学习曲线长得多。外科医生在开始或继续 RALP 项目之前，应考虑他们是否能够积累足够的经验，以最小化不理想的肿瘤学结果。
