Surgeons Slow to Learn Keyhole Surgery for Prostate Cancer

Surgeons who operate on patients with prostate cancer find it harder to learn the skills needed to do the surgery with a laparoscope compared with traditional techniques, claims a new study.

Researchers at Memorial Sloan Kettering Cancer Center (MSKCC, New York, NY, USA) calculated the learning curve for surgeons who did prostate surgery using a laparoscope, and found that these surgeons had to do around 750 operations before they achieved the same low level of disease recurrence as other surgeons achieved after 250 traditional operations. The result is that patients are at increased risk of cancer recurrence if they are treated by surgeons who have anything less than the very highest levels of experience. The findings suggest that as inexperienced surgeons have lower rates of cure, prostate cancer patients should be advised to seek care from specialist cancer centers, where the surgeons specialize in the treatment of just one or two cancers.

The researchers also found that surgeons who already had experience of traditional prostate surgery had substantially worse results in terms of cancer recurrence when they first switched to doing surgery using a laparoscope than surgeons whose first experience of prostate surgery was using a laparoscope. In fact, the skills needed for laparoscopy were so hard to pick up for surgeons who already had previous experience of traditional prostate surgery that the authors suggested surgeons should not switch between open and laparoscopic procedures without a compelling reason. The study was published early online on April 1, 2009, in The Lancet Oncology.

"Laparoscopic radical prostatectomy appears to involve skills that do not translate well from open experience," concluded lead author Andrew Vickers, Ph.D., and colleagues of the department of epidemiology and biostatistics. "Clinical, educational and research initiatives are required in order to moderate the negative effects of the learning curve on clinical care."

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Memorial Sloan Kettering Cancer Center