Prostatectomy outcome depends on surgeon's experience

Prostate cancer patients treated by highly experienced surgeons are much more likely to be cancer-free 5 years after surgery than patients treated by surgeons with less experience, according to a study to be published in the Journal of the National Cancer Institute.

"The difference in outcome among patients who were treated by surgeons with varying degrees of experience is clinically relevant and likely reflects a true relationship between surgical technique and cancer control," said lead author Andrew Vickers, PhD, of Memorial Sloan-Kettering Cancer Center, New York.

Investigators analyzed the cancer outcomes of 7,765 prostate cancer patients who were treated with radical prostatectomy by one of 72 surgeons at four major U.S. academic medical centers over a 16-year period. Statistical models were used to evaluate the link between the total number of prostatectomies performed by the surgeon prior to each patient's operation and biochemical recurrence of prostate cancer.

The results showed that the risk of recurrence 5 years after surgery was 17.9% for patients treated by surgeons who had performed 10 operations and 10.7% for patients treated by surgeons who had performed 250 operations. This means that patients treated by inexperienced surgeons were nearly 70% more likely to have a recurrence of their prostate cancer than those who were treated by surgeons with greater experience. According to the analysis, one out of every 14 patients treated by an inexperienced surgeon will have a recurrence.

"The learning curve is steep and did not start to plateau until a surgeon had completed 250 prior operations," said senior author Peter Scardino, MD, also of Sloan-Kettering. "Surgeons with little experience get significantly poorer results than those who have more.

"Although the successful practice of surgery presumes a lifetime of learning, the large number of cases required before the learning curve plateaus suggests the need to expand opportunities for training in surgical technique for surgeons in the early years after residency training."