The Surgical Learning Curve for Prostate Cancer Control After Radical Prostatectomy

摘要: Background The learning curve for surgery — i.e., improvement in surgical outcomes with increasing surgeon experience remains primarily a theoretical concept; actual curves based on outcome data are rarely presented. We analyzed the prostate cancer recurrence after radical prostatectomy. Methods study cohort included 7765 patients who were treated prostatectomy by one of 72 surgeons at four major US academic medical centers between 1987 and 2003. For each patient, was coded as total number prostatectomies performed before patient ’ s operation. Multivariable survival – time regression models used to evaluate association recurrence, defined serum prostatespecific antigen (PSA) more than 0.4 ng/mL followed subsequent higher PSA level (i.e., bio che mical ), adjustment established clinical tumor characteristics. All P values two-sided. Results steep did not start plateau until had completed approximately 250 prior operations. predicted probabilities 5 years 17.9% (95% confidence interval [CI] = 12.1% 25.6%) 10 operations 10.7% CI 7.1% 15.9%) (difference 7.2%, 95% 4.6% 10.1%; <.001). This finding robust sensitivity analysis; particular, results unaffected if we restricted sample 1995, when stage migration related advent screening appeared largely complete. Conclusions As surgeon’s increases, control improves, presumably because improved technique. Further research is needed examine specific techniques experienced that associated outcomes.