The Australian laparoscopic radical prostatectomy learning curve

Marcus Handmer, Charles Chabert, Ronald Cohen, Troy Gianduzzo, Paul Kearns, Daniel Moon, Jason Ooi, Tom Shannon, David Sofield, Andrew Tan, Mark Louie-Johnsun

Research output: Contribution to journalArticle

Abstract

Background: International estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship-trained Australian surgeons. Methods: Prospectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n=900) were compared to their second 100 cases (S100, n=782) with two of nine surgeons completing fewer than 200 cases. Results: The mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high-, intermediate- and low-risk cases were 15, 59 and 26% for the F100 versus 20, 59 and 21% for the S100, respectively. Blood transfusions (2.4 versus 0.8%), mean blood loss (413 versus 378mL), mean operating time (193 versus 163min) and length of stay (2.7 versus 2.4days) were all lower in the S100. Histopathology was organ confined (pT2) in 76% of F100 and 71% of S100. Positive surgical margin (PSM) rate was 18.4% in F100 versus 17.5% in the S100 (P=0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5% (P=0.13), pT3a PSM 34.8 versus 40.5% (P=0.29) and pT3b PSM 52.9 versus 36.4% (P=0.14). Conclusion: There was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.

Original languageEnglish
Pages (from-to)100-103
JournalANZ Journal of Surgery
Volume88
Issue number1-2
DOIs
Publication statusPublished - Jan 2018

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Learning Curve
Prostatectomy
Prostate-Specific Antigen
Blood Transfusion
Margins of Excision
Length of Stay
Prostatic Neoplasms
Surgeons

Cite this

Handmer, M., Chabert, C., Cohen, R., Gianduzzo, T., Kearns, P., Moon, D., ... Louie-Johnsun, M. (2018). The Australian laparoscopic radical prostatectomy learning curve. ANZ Journal of Surgery, 88(1-2), 100-103. https://doi.org/10.1111/ans.14025
Handmer, Marcus ; Chabert, Charles ; Cohen, Ronald ; Gianduzzo, Troy ; Kearns, Paul ; Moon, Daniel ; Ooi, Jason ; Shannon, Tom ; Sofield, David ; Tan, Andrew ; Louie-Johnsun, Mark. / The Australian laparoscopic radical prostatectomy learning curve. In: ANZ Journal of Surgery. 2018 ; Vol. 88, No. 1-2. pp. 100-103.
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abstract = "Background: International estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship-trained Australian surgeons. Methods: Prospectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n=900) were compared to their second 100 cases (S100, n=782) with two of nine surgeons completing fewer than 200 cases. Results: The mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high-, intermediate- and low-risk cases were 15, 59 and 26{\%} for the F100 versus 20, 59 and 21{\%} for the S100, respectively. Blood transfusions (2.4 versus 0.8{\%}), mean blood loss (413 versus 378mL), mean operating time (193 versus 163min) and length of stay (2.7 versus 2.4days) were all lower in the S100. Histopathology was organ confined (pT2) in 76{\%} of F100 and 71{\%} of S100. Positive surgical margin (PSM) rate was 18.4{\%} in F100 versus 17.5{\%} in the S100 (P=0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5{\%} (P=0.13), pT3a PSM 34.8 versus 40.5{\%} (P=0.29) and pT3b PSM 52.9 versus 36.4{\%} (P=0.14). Conclusion: There was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.",
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Handmer, M, Chabert, C, Cohen, R, Gianduzzo, T, Kearns, P, Moon, D, Ooi, J, Shannon, T, Sofield, D, Tan, A & Louie-Johnsun, M 2018, 'The Australian laparoscopic radical prostatectomy learning curve' ANZ Journal of Surgery, vol. 88, no. 1-2, pp. 100-103. https://doi.org/10.1111/ans.14025

The Australian laparoscopic radical prostatectomy learning curve. / Handmer, Marcus; Chabert, Charles; Cohen, Ronald; Gianduzzo, Troy; Kearns, Paul; Moon, Daniel; Ooi, Jason; Shannon, Tom; Sofield, David; Tan, Andrew; Louie-Johnsun, Mark.

In: ANZ Journal of Surgery, Vol. 88, No. 1-2, 01.2018, p. 100-103.

Research output: Contribution to journalArticle

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AU - Cohen, Ronald

AU - Gianduzzo, Troy

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AB - Background: International estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship-trained Australian surgeons. Methods: Prospectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n=900) were compared to their second 100 cases (S100, n=782) with two of nine surgeons completing fewer than 200 cases. Results: The mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high-, intermediate- and low-risk cases were 15, 59 and 26% for the F100 versus 20, 59 and 21% for the S100, respectively. Blood transfusions (2.4 versus 0.8%), mean blood loss (413 versus 378mL), mean operating time (193 versus 163min) and length of stay (2.7 versus 2.4days) were all lower in the S100. Histopathology was organ confined (pT2) in 76% of F100 and 71% of S100. Positive surgical margin (PSM) rate was 18.4% in F100 versus 17.5% in the S100 (P=0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5% (P=0.13), pT3a PSM 34.8 versus 40.5% (P=0.29) and pT3b PSM 52.9 versus 36.4% (P=0.14). Conclusion: There was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.

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Handmer M, Chabert C, Cohen R, Gianduzzo T, Kearns P, Moon D et al. The Australian laparoscopic radical prostatectomy learning curve. ANZ Journal of Surgery. 2018 Jan;88(1-2):100-103. https://doi.org/10.1111/ans.14025