Effects of pathologic stage on the learning curve for radical prostatectomy: Evidence that recurrence in organ-confined cancer is largely related to inadequate surgical technique Journal Article


Authors: Vickers, A. J.; Bianco, F. J.; Gonen, M.; Cronin, A. M.; Eastham, J. A.; Schrag, D.; Klein, E. A.; Reuther, A. M.; Kattan, M. W.; Pontes, J. E.; Scardino, P. T.
Article Title: Effects of pathologic stage on the learning curve for radical prostatectomy: Evidence that recurrence in organ-confined cancer is largely related to inadequate surgical technique
Abstract: Objectives: We previously demonstrated that there is a learning curve for open radical prostatectomy. We sought to determine whether the effects of the learning curve are modified by pathologic stage. Methods: The study included 7765 eligible prostate cancer patients treated with open radical prostatectomy by one of 72 surgeons. Surgeon experience was coded as the total number of radical prostatectomies conducted by the surgeon prior to a patient's surgery. Multivariable regression models of survival time were used to evaluate the association between surgeon experience and biochemical recurrence, with adjustment for PSA, stage, and grade. Analyses were conducted separately for patients with organ-confined and locally advanced disease. Results: Five-year recurrence-free probability for patients with organ-confined disease approached 100% for the most experienced surgeons. Conversely, the learning curve for patients with locally advanced disease reached a plateau at approximately 70%, suggesting that about a third of these patients cannot be cured by surgery alone. Conclusions: Excellent rates of cancer control for patients with organ-confined disease treated by the most experienced surgeons suggest that the primary reason such patients recur is inadequate surgical technique. © 2008 European Association of Urology.
Keywords: treatment outcome; disease-free survival; surgical technique; retrospective studies; major clinical study; histopathology; cancer recurrence; advanced cancer; united states; cancer patient; cancer staging; follow-up studies; neoplasm staging; cancer grading; prostate specific antigen; neoplasm recurrence, local; incidence; tumor markers, biological; prostate cancer; prostate-specific antigen; prostatic neoplasms; survival time; decision analysis; physicians; clinical competence; prostatectomy; surgeon; cancer control; surgical learning curve
Journal Title: European Urology
Volume: 53
Issue: 5
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2008-05-01
Start Page: 960
End Page: 966
Language: English
DOI: 10.1016/j.eururo.2008.01.005
PUBMED: 18207316
PROVIDER: scopus
PMCID: PMC2637145
DOI/URL:
Notes: --- - "Cited By (since 1996): 47" - "Export Date: 17 November 2011" - "CODEN: EUURA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Peter T Scardino
    622 Scardino
  2. Mithat Gonen
    723 Gonen
  3. Deborah Schrag
    137 Schrag
  4. Andrew J Vickers
    570 Vickers
  5. Angel M Cronin
    145 Cronin
  6. James Eastham
    429 Eastham
  7. Fernando J Bianco
    72 Bianco