Prostatectomy Patient Outcomes Affected by Surgeon's Total Case Load

A new study suggests that prostate cancer patients treated by more experienced urologic surgeons with higher volumes of surgery achieve improved results.

Researchers at the Memorial Sloan-Kettering Cancer Center (New York, NY, USA) analyzed data from the 2005 U.S. Nationwide Inpatient Sample and a complete record of all hospital discharges in New York State (USA) to determine typical annual radical prostatectomy caseloads of surgeons in the United States. The results show that a surgeon needs to have completed a minimum of 250 prostatectomies to reach the "learning curve plateau,” at which point cancer cure is maximized and surgical complications minimized. After adjusting for tumor severity, a typical patient treated by a surgeon who has reached the learning curve plateau had a 10.9% risk of recurrence at 5 years, compared to 17.7% for those treated by a less experienced surgeon. Similarly, surgical complications were decreased by 20% in patients treated by the highest versus the lowest volume surgeons studied.

Furthermore, for the 75% of patients diagnosed with cancers still confined to the prostate gland, the most highly experienced surgeons--who had performed at least 1,500 prior surgeries--achieved recurrence rates of less than 1%, suggesting that recurrence is largely dependent on surgical technique. Despite these findings, the researchers found that approximately 25% of U.S. surgeons performed only a single radical prostatectomy procedure per year, while about 80% of the surgeons performed fewer than 10 procedures per year. In all, according to the study, only 1.8% of surgeons in the United States perform more than 50 prostatectomies per year, and most surgeons will never reach the key threshold of 250 radical prostatectomy cases during their surgical careers. The study was published in the December 2009 issue of the Journal of Urology.

"The current pattern of surgical treatment for prostate cancer leads to many patients being treated by surgeons with low annual caseloads, with likely poorer outcomes as a result,” concluded study authors Caroline Savage, B.A., and Andrew Vickers, Ph.D., of the department of epidemiology and biostatistics.

"Practice patterns in which the majority of prostate cancers patients undergoing surgery are treated by surgeons performing fewer than 10 procedures a year suggest that better results may be achievable for many of these men,” commented Kevin Slawin, M.D., director of urology at Memorial Hermann-Texas Medical Center (Houston, USA). "The study provided data that supports what common sense suggests - that a more experienced surgeon will likely produce more positive results for patients undergoing a procedure as technically complex and challenging as radical prostatectomy.”

Related Links:
Memorial Sloan-Kettering Cancer Center
Memorial Hermann-Texas Medical Center