Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Eur Urol Oncol. 2023 Aug;6(4):414-421. doi: 10.1016/j.euo.2022.06.010. Epub 2022 Jul 15.
Improved cancer control with increasing surgical experience-the learning curve-was demonstrated for open and laparoscopic prostatectomy. In a prior single-center study, we found that this might not be the case for robot-assisted radical prostatectomy (RARP).
To investigate the relationship between prior experience of a surgeon and biochemical recurrence (BCR) after RARP.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively analyzed the data of 8101 patients with prostate cancer treated with RARP by 46 surgeons at nine institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation.
We evaluated the relationship of prior surgeon experience with the probability of BCR adjusting for preoperative prostate-specific antigen, pathologic stage, grade, lymph-node involvement, and year of surgery.
Overall, 1047 patients had BCR. The median follow-up for patients without BCR was 33 mo (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p = 0.2). The 5-yr BCR-free survival rates for a patient treated by a surgeon with prior 10, 250, and 1000 procedures performed were, respectively, 82.0%, 82.7%, and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% [95% confidence interval: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses.
These findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve.
We investigated the relationship between biochemical recurrence after robot-assisted radical prostatectomy and surgeon's experience. Surgeons at an early stage of their career had similar outcomes to those of more experienced surgeons, and we hypothesized that surgical education in robotics might be an important determinant of such a finding.
在开放和腹腔镜前列腺切除术方面，随着手术经验的增加，癌症控制得到改善，即学习曲线。在之前的单中心研究中，我们发现机器人辅助根治性前列腺切除术（RARP）可能并非如此。
研究外科医生既往经验与 RARP 后生化复发（BCR）之间的关系。
设计、地点和参与者：我们回顾性分析了 2003 年至 2021 年期间，9 家机构的 46 名外科医生对 8101 例前列腺癌患者进行 RARP 的数据。手术经验由外科医生在患者手术前进行的机器人前列腺切除术总数编码。
我们评估了外科医生既往经验与调整术前前列腺特异性抗原、病理分期、分级、淋巴结受累和手术年份后 BCR 概率之间的关系。
总体而言，有 1047 例患者发生 BCR。无 BCR 患者的中位随访时间为 33 个月（四分位距：14，61）。在调整病例组合后，手术经验与手术后 BCR 风险之间的关系无统计学意义（p=0.2）。由经验为 10 例、250 例和 1000 例手术的外科医生治疗的患者，5 年 BCR 无复发生存率分别为 82.0%、82.7%和 84.8%（10 例和 1000 例手术之间的绝对差异：1.6%[95%置信区间：0.4%，3.3%]）。结果在多项敏感性分析中具有稳健性。
这些发现表明，与开放和腹腔镜根治性前列腺切除术不同，RARP 外科医生在职业生涯的早期阶段就能实现足够的癌症控制。进一步的研究应该探讨为什么机器人手术的学习曲线与先前开放和腹腔镜根治性前列腺切除术的研究结果不同。我们假设手术教育，包括模拟培训和采用客观绩效指标，是一个重要的机制，可以使学习曲线变平。
我们研究了机器人辅助根治性前列腺切除术后生化复发与外科医生经验之间的关系。处于职业生涯早期的外科医生的结果与经验更丰富的外科医生相似，我们假设机器人手术的手术教育可能是这种发现的一个重要决定因素。
