Impact of Surgeon Experience on Outcomes in Prostate Cancer Surgery; A Study of Learning Curves and Best Practices
Keywords:
Prostate cancer, Radical prostatectomy, Surgeon experience, Learning curve, Surgical outcomesAbstract
Background: Prostate cancer is a significant health concern globally, and the success of radical prostatectomy, a standard treatment for localized prostate cancer, is heavily influenced by the surgeon's experience. Understanding the learning curves associated with this procedure is crucial for optimizing patient outcomes. Objective: This study aims to evaluate the impact of surgeon experience on the outcomes of prostate cancer surgery, specifically examining the learning curves and identifying best practices to enhance surgical success. Method: A prospective study was conducted on 46 patients undergoing radical prostatectomy at Dhaka Medical College Hospital and Dhaka Central International Medical College Hospital between October 2020 and September 2022. The patients were divided into two groups based on the surgeon's experience: Group A (less experienced surgeons, <100 procedures) and Group B (experienced surgeons, ≥100 procedures). Surgical outcomes were analyzed and compared, including operative time, intraoperative complications, postoperative complications, and oncological outcomes. Results: The study found that patients in Group B (experienced surgeons) had significantly better outcomes than Group A. Operative time was reduced by 25% in Group B, and the rate of intraoperative complications was 12% in Group B compared to 28% in Group A. Additionally, Group B had lower rates of positive surgical margins (18% vs. 34%) and improved postoperative recovery, with a 22% reduction in hospital stay duration. Conclusions: Surgeon experience plays a crucial role in the success of prostate cancer surgery. Patients operated on by more experienced surgeons demonstrated better surgical and oncological outcomes.
References
1. Bravi, C. A., Tin, A., Vertosick, E., Mazzone, E., Martini, A., Dell'Oglio, P., ... & Vickers, A. (2019). The impact of experience on the risk of surgical margins and biochemical recurrence after robot-assisted radical prostatectomy: a learning curve study. The Journal of urology, 202(1), 108-113.
2. Slusarenco, R. I., Mikheev, K. V., Prostomolotov, A. O., Sukhanov, R. B., & Bezrukov, E. A. (2020). Analysis of learning curve in robot‐assisted radical prostatectomy performed by a surgeon. Advances in Urology, 2020(1), 9191830.
3. Bravi, C. A., Dell'Oglio, P., Mazzone, E., Moschovas, M. C., Falagario, U., Piazza, P., ... & Mottrie, A. (2023). The surgical learning curve for biochemical recurrence after robot-assisted radical prostatectomy. European Urology Oncology, 6(4), 414-421.
4. Moretti, T. B., Magna, L. A., & Reis, L. O. (2023). Radical prostatectomy technique dispute: analyzing over 1.35 million surgeries in 20 years of history. Clinical Genitourinary Cancer, 21(4), e271-e278.
5. Moretti, T. B. C., Magna, L. A., & Reis, L. O. (2022). Surgical results and complications for open, laparoscopic, and robot-assisted radical prostatectomy: a reverse systematic review. European Urology Open Science, 44, 150-161.
6. Godtman, R. A., Persson, E., Cazzaniga, W., Sandin, F., Carlsson, S., Ahlgren, G., ... & Stattin, P. (2021). Association of surgeon and hospital volume with short-term outcomes after robot-assisted radical prostatectomy: Nationwide, population-based study. PLoS One, 16(6), e0253081.
7. Artsen, A. M., S Burkett, L., Duvvuri, U., & Bonidie, M. (2022). Surgeon satisfaction and outcomes of tele-proctoring for robotic gynecologic surgery. Journal of Robotic Surgery, 1-6.
8. Gavrilovska-Brzanov, A., Mojsova-Mijovska, M., Petrusheva-Panovska, A., Shabani, B., Jovanovski-Srceva, M., & Kuzmanovska, B. (2020). OUR INITIAL EXPERIENCE WITH LAPAROSCOPIC RADICAL CYSTECTOMY. Macedonian Journal of Anesthesia.
9. Guimarães, G. C., Oliveira, R. A. R. D., Santana, T. B. M., Favaretto, R. D. L., Mourão, T. C., Rocha, M. M., ... & Zequi, S. D. C. (2019). Comparative analysis of functional outcomes between two different techniques after 1088 robotic-assisted radical prostatectomies in a high-volume cancer center: a clipless approach. Journal of Endourology, 33(12), 1017-1024.
10. Grivas, N., Zachos, I., Georgiadis, G., Karavitakis, M., Tzortzis, V., & Mamoulakis, C. (2022). Learning curves in laparoscopic and robot-assisted prostate surgery: a systematic search and review. World Journal of Urology, 1-21.
11. Biswas, B., Chowdhury, A. S., Akter, S., Fatema, K., Reem, C. S. A., Tuhin, E., & Hasan, H. (2024). Knowledge and attitude about COVID-19 and importance of diet: A cross-sectional study among Bangladeshi people. Bangladesh Journal of Food and Nutrition, 1(1), 04-12.
12. Aktar, S., Akter, K., Akther, K., Begum, S., Islam, T., & Hasan, H. (2022). Knowledge Regarding the Prevention of Cervical Cancer of Adolescent Girls at Rajshahi Division.
13. Tamhankar, A., Spencer, N., Hampson, A., Noel, J., El-Taji, O., Arianayagam, R., ... & Vasdev, N. (2020). Real-time assessment of learning curve for robot-assisted laparoscopic prostatectomy. The Annals of The Royal College of Surgeons of England, 102(9), 717-725.
14. Antonelli, A., Palumbo, C., Noale, M., Porreca, A., Maggi, S., Simeone, C., ... & Pros-IT CNR study group. (2019). Impact of surgical approach on patient-reported outcomes after radical prostatectomy: a propensity score-weighted analysis from a multicenter, prospective, observational study (The Pros-IT CNR Study). Urologia internationalis, 103(1), 8-18.
15. Song, W., Lee, S. W., Chung, J. H., Kang, M., Sung, H. H., Jeon, H. G., ... & Jeon, S. S. (2020). Relationship between robotic-assisted radical prostatectomy and retropubic radical prostatectomy in the learning curve of a single surgeon as a novice in radical prostatectomy: A retrospective cohort study. International Journal of Surgery, 81, 74-79.
16. Carneiro, A., Claros, O. R., Cha, J. D., Kayano, P. P., Apezzato, M., Wagner, A. A., & Lemos, G. C. (2022). Can remote assistance for robotic surgery improve surgical performance in simulation training? A prospective clinical trial of urology residents using a simulator in south america. International braz j urol, 48, 952-960.
17. Azhar, R. A., Aldousari, S., Alghamdi, M. M., Alotaibi, M. F., Alkhateeb, S. S., Nassir, A. M., ... & Rabah, D. (2021). Robot-assisted radical prostatectomy in low-volume regions: Should it be abandoned or adopted? A multi-Institutional outcome study. Journal of Endourology, 35(7), 1013-1019.
18. Blute, M. L. (2008). Radical prostatectomy by open or laparoscopic/robotic techniques: an issue of surgical device or surgical expertise?. Journal of Clinical Oncology, 26(14), 2248-2249.
19. Marino, F., Moretto, S., Rossi, F., Gandi, C., Gavi, F., Bientinesi, R., ... & Sacco, E. (2024). Robot-Assisted Radical Prostatectomy Performed with the Novel Hugo™ RAS System: A Systematic Review and Pooled Analysis of Surgical, Oncological, and Functional Outcomes. Journal of Clinical Medicine, 13(9), 2551.
20. Ryan, J. P., Lynch, O., Broe, M. P., Swan, N., Moran, D., McGuire, B., & Mulvin, D. (2022). Robotic-assisted radical prostatectomy—impact of a mentorship program on oncological outcomes during the learning curve. Irish Journal of Medical Science (1971-), 1-6.
21. Entwistle, M. R. (2021). Dietary patterns and cancer in the United States. University of California, Merced.
22. Scarcia, M., Zazzara, M., Divenuto, L., Cardo, G., Portoghese, F., Romano, M., & Ludovico, G. M. (2018). Extraperitoneal robot-assisted radical prostatectomy: a high-volume surgical center experience. Minerva Urologica e Nefrologica= The Italian Journal of Urology and Nephrology, 70(5), 479-485.
