Da Cruz Jose Arnaldo Shiomi, Porto Breno Cordeiro, Terada Bruno Damico, Gonçalves Felipe Giraldo Alvarez, Orra Soraya Hussein, Martinez Juan Victor Nabhan, Passerotti Carlo Camargo, Sardenberg Rodrigo A S, De Almeida Kenneth Nunes Tavares, Artifon Everson Luiz De Almeida, Otoch Jose Pinhata
Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
International Teaching and Research Institute - Hapvida NotreDame Intermédica, São Paulo, Brazil.
BMC Urol. 2025 May 7;25(1):116. doi: 10.1186/s12894-025-01810-x.
Radical prostatectomy is a key treatment for prostate cancer. However, the impact of the learning curve of the surgeon has on the pentafecta is unclear. This meta-analysis aims to determine the impact of a procedure being performed in the initial learning curve has on the surgical results.
A systematic review of MEDLINE, Embase, Scopus, Web of Science, and Google Scholar was conducted up to March 2024, focusing on learning curves in prostatectomy. Primary outcome was biochemical recurrence rate (BCR); secondary outcomes included positive surgical margin (PSM) rate, continence, potency, operative time, blood loss, and complications (Clavien-Dindo classification). Bias was assessed using the ROBINS-I tool, and statistical analysis was done via Review Manager 5.4.
Sixteen studies with 21,851 patients were included. No significant difference in BCR rates was found between initial and advanced learning curves (OR1.44;95%CI0.97,2.13;p = 0.07;I²=74%). No significant difference in continence rates was also observed. (RD-0.05;95CI-0.10,0.01;p = 0.08;I²=86%). However, advanced learning curves showed lower PSM rates (OR1.61;95%CI1.19,2.17;p = 0.002;I²=88%), higher potency, less blood loss, shorter operative time, and fewer complications. Although randomized trials are unlikely in this context, further high-quality prospective studies are needed to validate these findings.
This meta-analysis highlights that achieving favorable outcomes in key pentafecta parameters-particularly potency, continence, and complication rates-increases with surgical experience. These findings emphasize the value of structured mentorship and establishing surgical volume benchmarks in training programs. Our analysis suggests that reaching a threshold of 100 cases may be necessary to consistently attain optimal functional and perioperative results.
根治性前列腺切除术是前列腺癌的关键治疗方法。然而，外科医生的学习曲线对五项完美指标的影响尚不清楚。本荟萃分析旨在确定在初始学习曲线阶段进行手术对手术结果的影响。
截至2024年3月，对MEDLINE、Embase、Scopus、Web of Science和谷歌学术进行了系统综述，重点关注前列腺切除术的学习曲线。主要结局是生化复发率（BCR）；次要结局包括手术切缘阳性（PSM）率、控尿、性功能、手术时间、失血量和并发症（Clavien-Dindo分类）。使用ROBINS-I工具评估偏倚，并通过Review Manager 5.4进行统计分析。
纳入了16项研究，共21851例患者。初始学习曲线和进阶学习曲线之间的BCR率无显著差异（OR 1.44；95%CI 0.97，2.13；p = 0.07；I² = 74%）。控尿率也未观察到显著差异（RD -0.05；95%CI -0.10，0.01；p = 0.08；I² = 86%）。然而，进阶学习曲线显示出较低的PSM率（OR 1.61；95%CI 1.19，2.17；p = 0.002；I² = 88%）、更高的性功能、更少的失血量、更短的手术时间和更少的并发症。尽管在这种情况下不太可能进行随机试验，但需要进一步的高质量前瞻性研究来验证这些发现。
本荟萃分析强调，在五项完美指标的关键参数（特别是性功能、控尿和并发症发生率）方面取得良好结果会随着手术经验的增加而提高。这些发现强调了结构化指导以及在培训项目中建立手术量基准的价值。我们的分析表明，可能有必要达到100例的阈值才能持续获得最佳的功能和围手术期结果。
