Oberlin Daniel T, Flum Andrew S, Lai Jeremy D, Meeks Joshua J
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Urol Oncol. 2016 Jun;34(6):255.e1-5. doi: 10.1016/j.urolonc.2016.01.008. Epub 2016 Feb 28.
To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years.
A total of 6-month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using Current Procedural Terminology codes for open radical prostatectomy (ORP) and laparoscopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0.
A total of 6,563 urologists submitted case logs, of which 68% (4,470/6,563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376% increase in the performance of RALP over the study period with robotic volume increasing from 22% of all RP in 2003 to 85% in 2013. Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (P<0.001). Overall, 39% of surgeons logging ORP performed 2 or fewer RP, whereas 19% of surgeons who performed RALP performed 2 or less RP (P<0.001). The highest volume robotic surgeons (top 10% surgical volume) performed 41% of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1% of all surgeons performing RP and performed 15.1% of all RP (P<0.001); general urologists performed the majority of RP (57.8%). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared with general surgeons (47% vs. 25.9%, respectively, P<0.001).
Robotic prostatectomies are performed 5 times more commonly than open prostatectomy and represent 85% of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared with general urologists.
为了确定机器人前列腺切除术如何影响泌尿外科医生的手术方式，我们研究了经认证的泌尿外科医生治疗前列腺癌的手术量特征。我们假设在过去10年中，开放性和机器人前列腺切除术以及淋巴结清扫术的应用呈动态变化。
获取了美国泌尿外科委员会2003年至2013年期间经认证的泌尿外科医生6个月的病例记录数据。使用当前手术操作术语代码识别开放性根治性前列腺切除术（ORP）以及腹腔镜或机器人辅助腹腔镜前列腺切除术（RALP）的病例，并通过ICD-9代码185.0定义的相应前列腺癌诊断进行确认。
共有6563名泌尿外科医生提交了病例记录，其中68%（4470/6563）报告至少进行了一次根治性前列腺切除术（RP），共记录了46030例RP。在研究期间，RALP的手术量增加了376%，机器人手术量从2003年占所有RP的22%增加到2013年的85%。在进行ORP的外科医生中，手术中位数为2例；在进行RALP的外科医生中，手术中位数为8例（P<0.001）。总体而言，记录ORP的外科医生中有39%进行了2例或更少的RP，而进行RALP的外科医生中有19%进行了2例或更少的RP（P<0.001）。手术量最高的机器人手术医生（手术量排名前10%）进行了所有RALP的41%，手术量最高的机器人手术医生在6个月内记录了658例前列腺切除术。肿瘤学家占所有进行RP的外科医生的4.1%，进行了所有RP的15.1%（P<0.001）；普通泌尿外科医生进行了大多数的RP（57.8%）。当采用开放手术时，外科医生的专业对淋巴结清扫术（LND）的实施没有影响；如果采用机器人手术，与普通外科医生相比，肿瘤学家进行LND的可能性显著更高（分别为47%和25.9%，P<0.001）。
机器人前列腺切除术的实施频率比开放性前列腺切除术高5倍，占2013年经委员会认证的泌尿外科医生进行的所有RP的85%。与RALP相比，ORP更有可能由手术量较低的外科医生进行。与普通泌尿外科医生相比，肿瘤学家进行RP的相对比例更高，并且如果采用机器人手术，进行LND的可能性显著更高。
