澳大利亚腹腔镜根治性前列腺切除术的学习曲线。

The Australian laparoscopic radical prostatectomy learning curve.

作者信息

Handmer Marcus, Chabert Charles, Cohen Ronald, Gianduzzo Troy, Kearns Paul, Moon Daniel, Ooi Jason, Shannon Tom, Sofield David, Tan Andrew, Louie-Johnsun Mark

机构信息

Department of Urology, The University of Newcastle, Gosford Hospital, Gosford, New South Wales, Australia.

Department of Urology, Pindara Gold Coast Private Hospital, Gold Coast, Queensland, Australia.

出版信息

ANZ J Surg. 2018 Jan;88(1-2):100-103. doi: 10.1111/ans.14025. Epub 2017 May 16.

DOI:10.1111/ans.14025

PMID:28512777

Abstract

BACKGROUND

International estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship-trained Australian surgeons.

METHODS

Prospectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n = 900) were compared to their second 100 cases (S100, n = 782) with two of nine surgeons completing fewer than 200 cases.

RESULTS

The mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high-, intermediate- and low-risk cases were 15, 59 and 26% for the F100 versus 20, 59 and 21% for the S100, respectively. Blood transfusions (2.4 versus 0.8%), mean blood loss (413 versus 378 mL), mean operating time (193 versus 163 min) and length of stay (2.7 versus 2.4 days) were all lower in the S100. Histopathology was organ confined (pT2) in 76% of F100 and 71% of S100. Positive surgical margin (PSM) rate was 18.4% in F100 versus 17.5% in the S100 (P = 0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5% (P = 0.13), pT3a PSM 34.8 versus 40.5% (P = 0.29) and pT3b PSM 52.9 versus 36.4% (P = 0.14).

CONCLUSION

There was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.

摘要

背景

国际上对腹腔镜根治性前列腺切除术（LRP）学习曲线的估计多达1000例，但对于接受过专科培训的澳大利亚外科医生而言尚不清楚。

方法

回顾性分析前瞻性收集的9名澳大利亚外科医生连续进行的2943例LRP病例的数据。将他们最初的100例病例（F100，n = 900）与第二个100例病例（S100，n = 782）进行比较，9名外科医生中有2名完成的病例少于200例。

结果

F100和S100之间的平均年龄（61.1岁对61.1岁）和前列腺特异性抗原（7.4对7.8 ng/mL）相似。F100的达米科高、中、低风险病例分别为15%、59%和26%，而S100分别为20%、59%和21%。S100的输血率（2.4%对0.8%）、平均失血量（413 mL对378 mL）、平均手术时间（193分钟对163分钟）和住院时间（2.7天对2.4天）均较低。F100的76%和S100的71%组织病理学结果为器官局限性（pT2）。F100的手术切缘阳性（PSM）率为18.4%，S100为17.5%（P = 0.62）。F100和S100按病理分期的PSM率相似，pT2期PSM为12.2%对9.5%（P = 0.13），pT3a期PSM为34.8%对40.5%（P = 0.29），pT3b期PSM为52.9%对36.4%（P = 0.14）。