David Bock1, Martin Nyberg2,3, Anna Lantz4,5, Sigrid V Carlsson6,7, Daniel D Sjoberg6, Stefan Carlsson4, Johan Stranne7,8, Gunnar Steineck9, Peter Wiklund10, Eva Haglind1,11, Anders Bjartell2,3. 1. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Gothenburg, Sweden. 2. Department of Translational Medicine, Division of Urological Cancers, Faculty of Medicine, Lund University, Lund, Sweden. 3. Department of Urology, Skåne University Hospital, Malmö, Sweden. 4. Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden. 5. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 6. Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 7. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 8. Department of Urology Gothenburg, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden. 9. Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. 10. Department of Urology, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA. 11. Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Abstract
OBJECTIVE: Differences in outcome after radical prostatectomy for prostate cancer can partly be explained by intersurgeon differences, where degree of experience is one important aspect. This study aims to define the learning curve of robot-assisted laparoscopic prostatectomy (RALP) regarding oncological and functional outcomes. MATERIALS AND METHODS: Out of 4003 enrolled patients in the LAPPRO trial, 3583 met the inclusion criteria, of whom 885 were operated on by an open technique. In total, 2672 patients with clinically localized prostate cancer from seven Swedish centres were operated on by RALP and followed for 8 years (LAPPRO trial). Oncological outcomes were pathology-reported surgical margins and biochemical recurrence at 8 years. Functional outcomes included patient-reported urinary incontinence and erectile dysfunction at 3, 12 and 24 months. Experience was surgeon-reported experience before and during the study. The relationship between surgeon experience and functional outcomes and surgical margin status was analysed by mixed-effects logistic regression. Biochemical recurrence was analysed by Cox regression, with robust standard errors. RESULTS: The learning curve for positive surgical margins was relatively flat, with rates of 21% for surgeons who had performed 0-74 cases and 24% for surgeons with > 300 cases. Biochemical recurrence at 4 years was 11% (0-74 cases) and 13% (> 300 cases). Incontinence was stable over the learning curve, but erectile function improved at 2 years, from 38% (0-74 cases) to 53% (> 300 cases). CONCLUSIONS: Analysis of the learning curve for surgeons performing RALP showed that erectile function improved with increasing number of procedures, which was not the case for oncological outcomes.
OBJECTIVE: Differences in outcome after radical prostatectomy for prostate cancer can partly be explained by intersurgeon differences, where degree of experience is one important aspect. This study aims to define the learning curve of robot-assisted laparoscopic prostatectomy (RALP) regarding oncological and functional outcomes. MATERIALS AND METHODS: Out of 4003 enrolled patients in the LAPPRO trial, 3583 met the inclusion criteria, of whom 885 were operated on by an open technique. In total, 2672 patients with clinically localized prostate cancer from seven Swedish centres were operated on by RALP and followed for 8 years (LAPPRO trial). Oncological outcomes were pathology-reported surgical margins and biochemical recurrence at 8 years. Functional outcomes included patient-reported urinary incontinence and erectile dysfunction at 3, 12 and 24 months. Experience was surgeon-reported experience before and during the study. The relationship between surgeon experience and functional outcomes and surgical margin status was analysed by mixed-effects logistic regression. Biochemical recurrence was analysed by Cox regression, with robust standard errors. RESULTS: The learning curve for positive surgical margins was relatively flat, with rates of 21% for surgeons who had performed 0-74 cases and 24% for surgeons with > 300 cases. Biochemical recurrence at 4 years was 11% (0-74 cases) and 13% (> 300 cases). Incontinence was stable over the learning curve, but erectile function improved at 2 years, from 38% (0-74 cases) to 53% (> 300 cases). CONCLUSIONS: Analysis of the learning curve for surgeons performing RALP showed that erectile function improved with increasing number of procedures, which was not the case for oncological outcomes.
Authors: Andrew Vickers; Fernando Bianco; Angel Cronin; James Eastham; Eric Klein; Michael Kattan; Peter Scardino Journal: J Urol Date: 2010-02-19 Impact factor: 7.450
Authors: Anna Wallerstedt; Tommy Nyberg; Stefan Carlsson; Thordis Thorsteinsdottir; Johan Stranne; Stavros I Tyritzis; Karin Stinesen Kollberg; Jonas Hugosson; Anders Bjartell; Ulrica Wilderäng; Peter Wiklund; Gunnar Steineck; Eva Haglind Journal: Eur Urol Focus Date: 2018-02-01
Authors: Fernando J Bianco; Andrew J Vickers; Angel M Cronin; Eric A Klein; James A Eastham; J Edson Pontes; Peter T Scardino Journal: J Urol Date: 2010-01-18 Impact factor: 7.450
Authors: Sigrid Carlsson; Anders Berglund; Daniel Sjoberg; Ali Khatami; Johan Stranne; Svante Bergdahl; Pär Lodding; Gunnar Aus; Andrew Vickers; Jonas Hugosson Journal: BMC Urol Date: 2014-03-06 Impact factor: 2.264
Authors: I van den Berg; S Buettner; R R J Coebergh van den Braak; K H J Ultee; H F Lingsma; J L A van Vugt; J N M Ijzermans Journal: J Gastrointest Surg Date: 2019-11-19 Impact factor: 3.267
Authors: Elin Axén; Rebecka Arnsrud Godtman; Anders Bjartell; Stefan Carlsson; Eva Haglind; Jonas Hugosson; Anna Lantz; Marianne Månsson; Gunnar Steineck; Peter Wiklund; Johan Stranne Journal: Eur Urol Open Sci Date: 2021-06-19