Impact of a multidisciplinary continuous quality improvement program on the positive surgical margin rate after laparoscopic radical prostatectomy Journal Article

   

Authors:	Touijer, K.; Kuroiwa, K.; Vickers, A.; Reuter, V. E.; Hricak, H.; Scardino, P. T.; Guillonneau, B.
Article Title:	Impact of a multidisciplinary continuous quality improvement program on the positive surgical margin rate after laparoscopic radical prostatectomy
Abstract:	Objective: Outcome after radical prostatectomy is highly sensitive to fine nuances in the surgical techniques. We sought to determine the impact of a process of continuous control and monitoring on the positive surgical margin rate in a contemporary series of laparoscopic radical prostatectomy. Methods: Between January 2003 and October 2004, 301 men underwent laparoscopic radical prostatectomy for clinically localized prostate cancer (cT1-cT3a). A weekly case review conference involving surgeons, radiologists, and uropathologists was held to discuss the preoperative, intraoperative, and pathologic findings of significant cases. We analyzed the trend of positive surgical margins and compared the clinical and detailed pathologic characteristics of the cancer during the study period. Results: We created logistic regression models with positive margin as the dependent variable and surgical experience as the predictor, adjusting for possible secular changes in disease severity (prostate-specific antigen, pathologic stage, and Gleason grade). There was a decrease in the rate of surgical margins: odds ratio 0.68/100 patients treated (95% confidence interval [CI] 0.44, 1.05; p = 0.08). The predicted probability for a positive surgical margin falls from 17.3% for the first patient to 7.5% for the 301st. These values are close to the observed rates for the first and last 50 patients. There was no important change in surgical risk over the course of the study, and the rate of nerve sparing remained stable throughout the study period. Conclusions: In this contemporary series, which is unaffected by downward stage migration, the decreasing rate of positive surgical margins can be explained by subtle surgical technique modifications and a continuous multidepartmental effort for quality improvement. © 2006 Elsevier B.V. All rights reserved.
Keywords:	adult; controlled study; treatment outcome; middle aged; surgical technique; retrospective studies; major clinical study; cancer localization; cancer risk; cancer patient; cancer staging; outcome assessment; follow-up studies; neoplasm staging; laparoscopy; cancer grading; laparoscopic surgery; preoperative evaluation; prostate specific antigen; neoplasm recurrence, local; patient assessment; patient monitoring; pathology; biopsy; prostate cancer; confidence interval; gleason score; prostatic neoplasms; health care quality; health care; disease severity; radiologist; program evaluation; quality assurance; quality assurance, health care; intraoperative period; prostatectomy; surgeon; experience; surgical risk; surgery; medical specialist; logistic regression analysis; sample size
Journal Title:	European Urology
Volume:	49
Issue:	5
ISSN:	0302-2838
Publisher:	Elsevier Science, Inc.
Date Published:	2006-05-01
Start Page:	853
End Page:	858
Language:	English
DOI:	10.1016/j.eururo.2005.12.065
PUBMED:	16455183
PROVIDER:	scopus
PMCID:	PMC1951513
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-33645770982&partnerID=40&md5=38f4215a040198c46aab152267334308
Notes:	--- - "Cited By (since 1996): 30" - "Export Date: 4 June 2012" - "CODEN: EUURA" - "Source: Scopus"

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