Paolo Dell'Oglio1, Elio Mazzone2, Edward Lambert3, Jonathan Vollemaere3, Marijn Goossens3, Alessandro Larcher4, Jolien Van Der Jeugt3, Gaetan Devos5, Filip Poelaert3, Pieter Uvin3, Justin Collins5, Geert De Naeyer3, Peter Schatteman3, Frederiek D'Hondt3, Alexandre Mottrie6. 1. ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. Electronic address: paolo.delloglio@gmail.com. 2. ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. 3. Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. 4. Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. 5. ORSI, Academy, Melle, Belgium. 6. ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
Abstract
BACKGROUND: Evidence on the learning curve for robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is limited. OBJECTIVE: To assess the effect of surgical experience (SE) on perioperative and intermediate-term oncological outcomes in a large contemporary cohort of RARC patients after accounting for the impact of intersurgeon variability. DESIGN, SETTING, AND PARTICIPANTS: The study cohort included 164 patients treated with RARC and ICUD by two surgeons between 2004 and 2017 at a single European referral centre. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: For each patient, SE was defined as the total number of RARCs performed by each surgeon before the patient's operation. The relationship between SE and operative time (OT), lymph node yield (LNY), positive surgical margins (PSMs), Clavien-Dindo grade ≥2 30-d postoperative complication (CD≥2), and oncological outcomes (18-mo recurrence rate) was evaluated in multivariable linear and logistic regression models, clustering at a single-surgeon level. RESULTS AND LIMITATIONS: After adjusting for case mix, SE was associated with shorter OT (p= 0.003), lower probability of postoperative CD≥2 rates (p= 0.01), and lower 18-mo recurrence rates (p= 0.002). Conversely, SE did not predict lower PSM rates (p= 0.3) and higher LNY (p= 0.4). The relationship between SE and OT was nonlinear, with a plateau observed after 50 cases. Conversely, the relationship between SE and CD≥2 and 18-mo recurrence was linear without reaching a plateau after 88 procedures. CONCLUSIONS: SE affects perioperative and oncological outcomes after RARC with ICUD in a linear fashion, and its beneficial effect does not reach a plateau. Conversely, after 50 cases, no further improvement was observed for OT. PATIENT SUMMARY: Robot-assisted radical cystectomy with intracorporeal urinary diversion is a complex surgical procedure with a relatively long learning curve.
BACKGROUND: Evidence on the learning curve for robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is limited. OBJECTIVE: To assess the effect of surgical experience (SE) on perioperative and intermediate-term oncological outcomes in a large contemporary cohort of RARC patients after accounting for the impact of intersurgeon variability. DESIGN, SETTING, AND PARTICIPANTS: The study cohort included 164 patients treated with RARC and ICUD by two surgeons between 2004 and 2017 at a single European referral centre. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: For each patient, SE was defined as the total number of RARCs performed by each surgeon before the patient's operation. The relationship between SE and operative time (OT), lymph node yield (LNY), positive surgical margins (PSMs), Clavien-Dindo grade ≥2 30-d postoperative complication (CD≥2), and oncological outcomes (18-mo recurrence rate) was evaluated in multivariable linear and logistic regression models, clustering at a single-surgeon level. RESULTS AND LIMITATIONS: After adjusting for case mix, SE was associated with shorter OT (p= 0.003), lower probability of postoperative CD≥2 rates (p= 0.01), and lower 18-mo recurrence rates (p= 0.002). Conversely, SE did not predict lower PSM rates (p= 0.3) and higher LNY (p= 0.4). The relationship between SE and OT was nonlinear, with a plateau observed after 50 cases. Conversely, the relationship between SE and CD≥2 and 18-mo recurrence was linear without reaching a plateau after 88 procedures. CONCLUSIONS: SE affects perioperative and oncological outcomes after RARC with ICUD in a linear fashion, and its beneficial effect does not reach a plateau. Conversely, after 50 cases, no further improvement was observed for OT. PATIENT SUMMARY: Robot-assisted radical cystectomy with intracorporeal urinary diversion is a complex surgical procedure with a relatively long learning curve.
Authors: Stefano Tappero; Paolo Dell'Oglio; Mattia Longoni; Carlo Buratto; Erika Palagonia; Pietro Scilipoti; Enrico Vecchio; Marco Martiriggiano; Silvia Secco; Alberto Olivero; Michele Barbieri; Giancarlo Napoli; Elena Strada; Giovanni Petralia; Dario Di Trapani; Aldo Massimo Bocciardi; Antonio Galfano Journal: World J Urol Date: 2022-06-30 Impact factor: 3.661
Authors: Elio Mazzone; Paolo Dell'Oglio; Nikos Grivas; Esther Wit; Maarten Donswijk; Alberto Briganti; Fijs Van Leeuwen; Henk van der Poel Journal: J Nucl Med Date: 2021-02-05 Impact factor: 10.057
Authors: Iulia Andras; Angelo Territo; Teodora Telecan; Paul Medan; Ion Perciuleac; Alexandru Berindean; Dan V Stanca; Maximilian Buzoianu; Ioan Coman; Nicolae Crisan Journal: J Clin Med Date: 2021-04-21 Impact factor: 4.241
Authors: Paolo Dell'Oglio; Filippo Turri; Alessandro Larcher; Frederiek D'Hondt; Rafael Sanchez-Salas; Bernard Bochner; Joan Palou; Robin Weston; Abolfazl Hosseini; Abdullah E Canda; Jørgen Bjerggaard; Giovanni Cacciamani; Kasper Ørding Olsen; Inderbir Gill; Thierry Piechaud; Walter Artibani; Pim J van Leeuwen; Arnulf Stenzl; John Kelly; Prokar Dasgupta; Carl Wijburg; Justin W Collins; Mihir Desai; Henk G van der Poel; Francesco Montorsi; Peter Wiklund; Alexandre Mottrie Journal: Eur Urol Focus Date: 2021-01-02
Authors: Carl J Wijburg; Gerjon Hannink; Charlotte T J Michels; Philip C Weijerman; Rami Issa; Andrea Tay; Karel Decaestecker; Peter Wiklund; Abolfazl Hosseini; Ashwin Sridhar; John Kelly; Frederiek d'Hondt; Alexandre Mottrie; Sjoerd Klaver; Sebastian Edeling; Paolo Dell'Oglio; Francesco Montorsi; Maroeska M Rovers; J Alfred Witjes Journal: Eur Urol Open Sci Date: 2022-04-02