Thomas Van den Broeck1, Daniela Oprea-Lager2, Lisa Moris3, Mithun Kailavasan4, Erik Briers5, Philip Cornford6, Maria De Santis7, Giorgio Gandaglia8, Silke Gillessen Sommer9, Jeremy P Grummet10, Nikos Grivas11, Thomas B L Lam12, Michael Lardas13, Matthew Liew14, Malcolm Mason15, Shane O'Hanlon16, Jakub Pecanka17, Guillaume Ploussard18, Olivier Rouviere19, Ivo G Schoots20, Derya Tilki21, Roderick C N van den Bergh22, Henk van der Poel23, Thomas Wiegel24, Peter-Paul Willemse25, Cathy Y Yuan26, Nicolas Mottet27. 1. Department of Urology, University Hospitals Leuven, Leuven, Belgium. Electronic address: thomas.vandenbroeck@uzleuven.be. 2. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, VU University, Amsterdam, The Netherlands. 3. Department of Urology, University Hospitals Leuven, Leuven, Belgium. 4. Leicester City Hospital, Leicester, UK. 5. Hasselt, Belgium. 6. Department of Urology, Liverpool University Hospitals, Liverpool, UK. 7. Department of Urology, Charité University Hospital, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria. 8. Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. 9. Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland. 10. Department of Surgery, Central Clinical School, Monash University, Australia. 11. Department of Urology, Hatzikosta General Hospital, Ioannina, Greece. 12. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK. 13. Department of Urology, Metropolitan General Hospital, Athens, Greece. 14. Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK. 15. Division of Cancer & Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK. 16. Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland. 17. Pecanka Consulting Services, Prague, Czech Republic. 18. La Croix du Sud Hospital, Quint Fonsegrives, France. 19. Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôspital Edouard Herriot, Lyon, France. 20. Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 21. Martini-Klinik Prostate Cancer Centre, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 22. Department of Urology, Antonius Hospital, Utrecht, The Netherlands. 23. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 24. Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany. 25. Department of Oncological Urology, University Medical Centre, Utrecht Cancer Centre, Utrecht, The Netherlands. 26. Department of Medicine, Health Science Centre, McMaster University, Hamilton, Ontario, Canada. 27. Department of Urology, University Hospital, St. Etienne, France.
Abstract
CONTEXT: The impact of surgeon and hospital volume on outcomes after radical prostatectomy (RP) for localised prostate cancer (PCa) remains unknown. OBJECTIVE: To perform a systematic review on the association between surgeon or hospital volume and oncological and nononcological outcomes following RP for PCa. EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. All comparative studies for nonmetastatic PCa patients treated with RP published between January 1990 and May 2020 were included. For inclusion, studies had to compare hospital or surgeon volume, defined as caseload per unit time. Main outcomes included oncological (including prostate-specific antigen persistence, positive surgical margin [PSM], biochemical recurrence, local and distant recurrence, and cancer-specific and overall survival) and nononcological (perioperative complications including need for blood transfusion, conversion to open procedure and within 90-d death, and continence and erectile function) outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Both a narrative and a quantitative synthesis were planned if the data allowed. EVIDENCE SYNTHESIS: Sixty retrospective comparative studies were included. Generally, increasing surgeon and hospital volumes were associated with lower rates of mortality, PSM, adjuvant or salvage therapies, and perioperative complications. Combining group size cut-offs as used in the included studies, the median threshold for hospital volume at which outcomes start to diverge is 86 (interquartile range [IQR] 35-100) cases per year. In addition, above this threshold, the higher the caseload, the better the outcomes, especially for PSM. RoB and confounding were high for most domains. CONCLUSIONS: Higher surgeon and hospital volumes for RP are associated with lower rates of PSMs, adjuvant or salvage therapies, and perioperative complications. This association becomes apparent from a caseload of >86 (IQR 35-100) per year and may further improve hereafter. Both high- and low-volume centres should measure their outcomes, make them publicly available, and improve their quality of care if needed. PATIENT SUMMARY: We reviewed the literature to determine whether the number of prostate cancer operations (radical prostatectomy) performed in a hospital affects the outcomes of surgery. We found that, overall, hospitals with a higher number of operations per year have better outcomes in terms of cancer recurrence and complications during or after hospitalisation. However, it must be noted that surgeons working in hospitals with lower annual operations can still achieve similar or even better outcomes. Therefore, making hospital's outcome data publicly available should be promoted internationally, so that patients can make an informed decision where they want to be treated.
CONTEXT: The impact of surgeon and hospital volume on outcomes after radical prostatectomy (RP) for localised prostate cancer (PCa) remains unknown. OBJECTIVE: To perform a systematic review on the association between surgeon or hospital volume and oncological and nononcological outcomes following RP for PCa. EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. All comparative studies for nonmetastatic PCa patients treated with RP published between January 1990 and May 2020 were included. For inclusion, studies had to compare hospital or surgeon volume, defined as caseload per unit time. Main outcomes included oncological (including prostate-specific antigen persistence, positive surgical margin [PSM], biochemical recurrence, local and distant recurrence, and cancer-specific and overall survival) and nononcological (perioperative complications including need for blood transfusion, conversion to open procedure and within 90-d death, and continence and erectile function) outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Both a narrative and a quantitative synthesis were planned if the data allowed. EVIDENCE SYNTHESIS: Sixty retrospective comparative studies were included. Generally, increasing surgeon and hospital volumes were associated with lower rates of mortality, PSM, adjuvant or salvage therapies, and perioperative complications. Combining group size cut-offs as used in the included studies, the median threshold for hospital volume at which outcomes start to diverge is 86 (interquartile range [IQR] 35-100) cases per year. In addition, above this threshold, the higher the caseload, the better the outcomes, especially for PSM. RoB and confounding were high for most domains. CONCLUSIONS: Higher surgeon and hospital volumes for RP are associated with lower rates of PSMs, adjuvant or salvage therapies, and perioperative complications. This association becomes apparent from a caseload of >86 (IQR 35-100) per year and may further improve hereafter. Both high- and low-volume centres should measure their outcomes, make them publicly available, and improve their quality of care if needed. PATIENT SUMMARY: We reviewed the literature to determine whether the number of prostate cancer operations (radical prostatectomy) performed in a hospital affects the outcomes of surgery. We found that, overall, hospitals with a higher number of operations per year have better outcomes in terms of cancer recurrence and complications during or after hospitalisation. However, it must be noted that surgeons working in hospitals with lower annual operations can still achieve similar or even better outcomes. Therefore, making hospital's outcome data publicly available should be promoted internationally, so that patients can make an informed decision where they want to be treated.
Authors: Markus Maier; Anne-Karoline Ebert; Martin Baunacke; Christer Groeben; Nicole Eisenmenger; Christian Thomas; Johannes Huber Journal: Urologe A Date: 2021-09-15 Impact factor: 0.639