Variations Among Experienced Surgeons in Cancer Control After Open Radical Prostatectomy
- 31 March 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 183 (3), 977-983
- https://doi.org/10.1016/j.juro.2009.11.015
Abstract
Purpose: Complications and functional outcomes after prostate surgery vary among surgeons to a greater extent than may be accounted for by chance. This excessive variation is known as heterogeneity. We explored whether there is also heterogeneity among high volume surgeons with respect to cancer control after surgery. Materials and Methods: The study cohort consisted of 7,725 patients with clinically localized prostate cancer treated with open radical prostatectomy at 4 major American academic medical centers from 1987 to 2003 by 1 of 54 surgeons. We defined biochemical recurrence as serum prostate specific antigen 0.4 ng/ml or greater followed by a higher level. Multivariate random effects models were used to evaluate prostate cancer recurrence heterogeneity among surgeons after adjusting for case mix (prostate specific antigen, pathological stage and grade), surgery year and surgeon experience. Results: We found statistically significant heterogeneity in the prostate cancer recurrence rate independent of surgeon experience (p = 0.002). Seven experienced surgeons had an adjusted 5-year prostate cancer recurrence rate of less than 10% while another 5 had a rate that exceeded 25%. Significant heterogeneity remained on sensitivity analysis adjusting for possible differences in followup, patient selection and stage migration. Conclusions: Patient risk of recurrence may differ depending on which of 2 surgeons is seen even if the surgeons have similar experience levels. Surgical randomized trials are imperative to determine and characterize the roots of these variations.Keywords
This publication has 14 references indexed in Scilit:
- Effects of Pathologic Stage on the Learning Curve for Radical Prostatectomy: Evidence That Recurrence in Organ-Confined Cancer Is Largely Related to Inadequate Surgical TechniqueEuropean Urology, 2008
- The Surgical Learning Curve for Prostate Cancer Control After Radical ProstatectomyJNCI Journal of the National Cancer Institute, 2007
- Surgical volume is related to the rate of positive surgical margins at radical prostatectomy in European patientsBJU International, 2006
- Defining Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy: A Proposal for a Standardized DefinitionJournal of Clinical Oncology, 2006
- DO MARGINS MATTER? THE PROGNOSTIC SIGNIFICANCE OF POSITIVE SURGICAL MARGINS IN RADICAL PROSTATECTOMY SPECIMENSJournal of Urology, 2005
- Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911)The Lancet, 2005
- VARIATIONS AMONG HIGH VOLUME SURGEONS IN THE RATE OF COMPLICATIONS AFTER RADICAL PROSTATECTOMY: FURTHER EVIDENCE THAT TECHNIQUE MATTERSJournal of Urology, 2005
- Radical Prostatectomy versus Watchful Waiting in Early Prostate CancerNew England Journal of Medicine, 2005
- Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trialsThe Lancet, 2005
- Pooled Analysis of Fluorouracil-Based Adjuvant Therapy for Stage II and III Colon Cancer: Who Benefits and by How Much?Journal of Clinical Oncology, 2004