Kretschmer Alexander, Mandel Philipp, Buchner Alexander, Stief Christian G, Tilki Derya
Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
World J Urol. 2015 Nov;33(11):1721-7. doi: 10.1007/s00345-015-1540-5. Epub 2015 Mar 21.
To analyze the impact of surgeon's experience on surgical margin status, postoperative continence and operative time after radical prostatectomy (RP) in a surgeon who performed more than 2000 open RP.
We retrospectively analyzed 2269 patients who underwent RP by one surgeon from April 2004 to June 2012. Multivariable logistic models were used to quantify the impact of surgeon's experience (measured by the number of prior performed RP) on surgical margin status, postoperative continence and operative time.
Negative surgical margin rate was 86 % for patients with pT2 stage, and continence rate at 3 years after RP was 94 %. Patients with negative surgical margin had lower preoperative PSA level (p = 0.02), lower pT stage (p < 0.001) and lower Gleason score (p < 0.001). The influence of the experience of the surgeon was nonlinear, positive and highly significant up to 750 performed surgeries (75-90 % negative surgical margin) (p < 0.01). The probability of continence rises significantly with surgeon's experience (from 88-96 %) (p < 0.05). A reduction in operative time (90-65 min) per RP was observed up to 1000 RP.
In the present study, we showed evidence that surgeon's experience has a strong positive impact on pathologic and functional outcomes as well as on operative time. While significant learning effects concerning positive surgical margin rate and preserved long-term continence were detectable during the first 750 and 300 procedures, respectively, improvement in operative time was detectable up to a threshold of almost 1000 RP and hence is relevant even for very high-volume surgeons.
分析一位实施过2000多例开放性根治性前列腺切除术（RP）的外科医生的经验对RP术后手术切缘状态、术后控尿情况及手术时间的影响。
我们回顾性分析了2004年4月至2012年6月间由同一位外科医生实施RP手术的2269例患者。采用多变量逻辑模型来量化外科医生的经验（以前实施RP手术的数量来衡量）对手术切缘状态、术后控尿情况及手术时间的影响。
pT2期患者的手术切缘阴性率为86%，RP术后3年的控尿率为94%。手术切缘阴性的患者术前前列腺特异抗原（PSA）水平较低（p = 0.02）、pT分期较低（p < 0.001）且Gleason评分较低（p < 0.001）。外科医生经验的影响是非线性的，在实施750例手术之前呈正向且高度显著（手术切缘阴性率为75 - 90%）（p < 0.01）。控尿概率随外科医生经验显著上升（从88 - 96%）（p < 0.05）。在实施1000例RP手术之前，每例RP手术的时间有所缩短（从90分钟减至65分钟）。
在本研究中，我们证明了外科医生的经验对病理和功能结果以及手术时间有强烈的正向影响。虽然分别在最初的750例和300例手术过程中可检测到手术切缘阳性率和长期控尿保留方面的显著学习效应，但手术时间的改善在实施近1000例RP手术之前均可检测到，因此即使对于手术量非常大的外科医生也有意义。
