Department of Urology, Charité-Universitätsmedizin and Hospital, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin and Hospital, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
J Endourol. 2023 Sep;37(9):995-1000. doi: 10.1089/end.2023.0137. Epub 2023 Jul 18.
We investigated whether pathological outcomes improved with experience and surgeon generation after robot-assisted laparoscopic prostatectomy (RALP). The study included 1338 patients who underwent RALP between February 2010 and April 2020. We created learning curves for pelvic lymph node dissection (PLND), number of lymph nodes (LNs) removed, and positive surgical margin (PSM) after adjustment for confounders. We compared the outcomes between the first and second generation of surgeons in regression models. The learning curve regarding PLND indications showed a significant increase with experience for the first generation, whereas the second generation had a learning curve that remained flat at a higher level (92.3%) and significantly better than the first generation ( < 0.001). Similarly, the number of LN removed showed a significant increase with experience in both generations, but the overall median number of LN removed was significantly higher in the second generation compared with the first generation (12 10, < 0.001). However, the learning curve for PSM remained flat at ∼20% after adjustment and did not show improvement with experience in both generations of surgeons ( = 0.794). Surgeons showed improvement with experience and education with RALP with respect to the indications for PLND and number of LNs removed. However, there was no improvement over time and generations for PSM. Experience based solely on the number of patients operated on is not an intrinsic factor in the pathological quality of RALP. Factors other than experience may also play a role in oncologic improvement.
我们研究了在机器人辅助腹腔镜前列腺切除术（RALP）后，经验和外科医生代际是否会改善病理结果。该研究纳入了 1338 名于 2010 年 2 月至 2020 年 4 月期间接受 RALP 的患者。我们创建了骨盆淋巴结清扫术（PLND）、切除的淋巴结数量（LNs）和阳性切缘（PSM）的学习曲线，对混杂因素进行了调整。我们在回归模型中比较了第一代和第二代外科医生的结果。PLND 适应证的学习曲线显示，第一代的经验增加显著，而第二代的学习曲线保持在较高水平（92.3%），且显著优于第一代（ < 0.001）。同样，在两代外科医生中，LN 切除的数量都随着经验的增加而显著增加，但第二代的总体中位 LN 切除数量明显高于第一代（12 10， < 0.001）。然而，PSM 的学习曲线在调整后仍保持在约 20%，且两代外科医生的经验均未显示出改善（ = 0.794）。外科医生在 RALP 的 PLND 适应证和 LN 切除数量方面表现出随着经验和教育的提高而提高。然而，在两代外科医生中，PSM 并没有随着时间和代际的推移而改善。仅基于手术患者数量的经验并不是 RALP 病理质量的内在因素。其他因素也可能在肿瘤学改善中发挥作用。
