Martiniclinic, Prostate Cancer Center University Hospital Hamburg-Eppendorf, Hamburg, Germany.
J Urol. 2010 Dec;184(6):2285-90. doi: 10.1016/j.juro.2010.08.024. Epub 2010 Oct 16.
Radical prostatectomy is the standard of care for localized prostate cancer. Numerous previous reports show the relationship between surgical experience and various outcomes. We examined the effect of surgical experience on complications and transfusion rates, and determined individual surgeon annual caseload trends in a contemporary radical prostatectomy cohort.
We analyzed annual caseload temporal trends in 34,803 patients who underwent surgery between 1999 and 2008 in Florida. Logistic regression models controlled for clustering among surgeons addressed the relationship of surgical experience, defined as the number of radical prostatectomies done since January 1, 1999 until each radical prostatectomy, with complications and transfusions.
During the study period the proportion of surgeons in the high annual caseload tertile (24 radical prostatectomies or greater yearly) and the proportion of patients treated by those surgeons increased from 5% to 10% and from 20% to 55%, respectively. Conversely complication and transfusion rates decreased from 14.3% to 9.2% and 12.6% to 6.9%, respectively. Radical prostatectomies done by surgeons in the high surgical experience tertile (86 or greater radical prostatectomies) decreased the risk of any complication by 33% and of any transfusion by 30% vs those in patients operated on by surgeons in the low surgical experience tertile (27 or fewer radical prostatectomies).
The proportion of surgeons in the high annual caseload tertile and the proportion of patients treated by these surgeons steadily increased during the last decade. Complication and transfusion rates decreased with time. The implications of these encouraging findings may result in improved outcomes in patients with surgically managed prostate cancer.
根治性前列腺切除术是局限性前列腺癌的标准治疗方法。大量先前的报告显示了手术经验与各种结果之间的关系。我们检查了手术经验对并发症和输血率的影响，并确定了当代根治性前列腺切除术队列中每位外科医生的年度病例量趋势。
我们分析了 1999 年至 2008 年间在佛罗里达州接受手术的 34803 名患者的年度病例量时间趋势。使用逻辑回归模型控制外科医生之间的聚类，研究了手术经验（定义为自 1999 年 1 月 1 日起至每次进行根治性前列腺切除术之间完成的根治性前列腺切除术数量）与并发症和输血之间的关系。
在研究期间，高年度病例量三分位（每年 24 例或更多）的外科医生比例和接受这些外科医生治疗的患者比例分别从 5%增加到 10%，从 20%增加到 55%。相反，并发症和输血的发生率从 14.3%下降到 9.2%，从 12.6%下降到 6.9%。高手术经验三分位（86 例或更多根治性前列腺切除术）的外科医生进行的根治性前列腺切除术可使任何并发症的风险降低 33%，任何输血的风险降低 30%，而低手术经验三分位（27 例或更少根治性前列腺切除术）的外科医生则降低。
在过去十年中，高年度病例量三分位的外科医生比例和接受这些外科医生治疗的患者比例稳步增加。并发症和输血率随时间降低。这些令人鼓舞的发现可能会导致接受手术治疗的前列腺癌患者的结局改善。
