The Australian laparoscopic radical prostatectomy learning curve. Issue 1 (16th May 2017)
- Record Type:
- Journal Article
- Title:
- The Australian laparoscopic radical prostatectomy learning curve. Issue 1 (16th May 2017)
- Main Title:
- The Australian laparoscopic radical prostatectomy learning curve
- Authors:
- Handmer, Marcus
Chabert, Charles
Cohen, Ronald
Gianduzzo, Troy
Kearns, Paul
Moon, Daniel
Ooi, Jason
Shannon, Tom
Sofield, David
Tan, Andrew
Louie‐Johnsun, Mark - Abstract:
- 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.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. … (more)
- Is Part Of:
- ANZ journal of surgery. Volume 88:Issue 1/2(2018)
- Journal:
- ANZ journal of surgery
- Issue:
- Volume 88:Issue 1/2(2018)
- Issue Display:
- Volume 88, Issue 1/2 (2018)
- Year:
- 2018
- Volume:
- 88
- Issue:
- 1/2
- Issue Sort Value:
- 2018-0088-NaN-0000
- Page Start:
- 100
- Page End:
- 103
- Publication Date:
- 2017-05-16
- Subjects:
- laparoscopic surgery -- learning curve -- prostatectomy
Surgery -- Periodicals
617.005 - Journal URLs:
- http://onlinelibrary.wiley.com/ ↗
- DOI:
- 10.1111/ans.14025 ↗
- Languages:
- English
- ISSNs:
- 1445-1433
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 1566.878000
British Library DSC - BLDSS-3PM
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- 5789.xml