Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/1217
Title: The Australian laparoscopic radical prostatectomy learning curve.
Epworth Authors: Moon, Daniel
Other Authors: Handmer, Marcus
Chabert, Charles
Cohen, Ronald
Gianduzzo, Troy
Kearns, Paul
Ooi, Jason
Shannon, Tom
Sofield, David
Tan, Andrew
Louie-Johnsun, Mark
Keywords: Laparoscopic Radical Prostatectomy
LRP
Laparoscopic Surgery
Prostatectomy
Learning Curve
Prostate Specific Antigen
Blood Transfusions
Blood Loss
Operating Time
Length of Stay
Histopathology
Positive Surgical Margin
PSM
Perioperative Outcomes
LRP Learning Curve
Laparoscopic Radical Prostatectomy Learning Curve
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Robotic Surgery, Epworth Healthcare, Australia
Issue Date: May-2017
Publisher: Wiley Online Library
Citation: ANZ J Surg. 2017 May 16
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.
URI: http://hdl.handle.net/11434/1217
DOI: 10.1111/ans.14025
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/28512777
ISSN: 1445-2197
1445-1443
Journal Title: ANZ Journal of Surgery
Type: Journal Article
Affiliated Organisations: Department of Urology, The University of Newcastle, Gosford Hospital, Gosford, New South Wales, Australia.
Department of Urology, Pindara Gold Coast Private Hospital, Gold Coast, Queensland, Australia.
Department of Pathology, Uropath Pty Ltd, Perth, Western Australia, Australia.
School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, Australia.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Department of Urology, The Wesley Hospital, Brisbane, Queensland, Australia.
Department of Urology, Geelong Hospital, Geelong, Victoria, Australia.
Department of Urology, St John of God Hospital, Melbourne, Victoria, Australia.
Department of Urology, Barwon Health University Hospital, Geelong, Victoria, Australia.
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Urology Unit, Western Hospital, Melbourne, Victoria, Australia.
Department of Urology, St Vincent's Private Hospital, Melbourne, Victoria, Australia.
Department of Urology, Hollywood Private Hospital, Nedlands, Western Australia, Australia.
Department of Urology, Bethesda Hospital, Perth, Western Australia, Australia.
Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia.
Department of Urology, Gosford Private Hospital, Gosford, New South Wales, Australia.
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:UroRenal, Vascular
Epworth Prostate Centre

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