Patients and Methods: Three hundred s consecutive patients underwent LRP between January 2005 and April 2011. Patients were divided into 3 equal groups (1-100 [Group 1], 101-200[Group 2], and 201-300 [Group 3]). Age, ASA score, preoperative co-morbidities and indications for LRP were comparable for all 3 patient groups. Peri-operative and oncological outcomes were compared across all 3 groups to assess the impact of the learning curve for LRP. All surgical complications were classified using the Clavien-Dindo system (CDS).
Results: The mean age was 61.9 years (Range 46-74). There was a significant reduction in the mean operating time (p< 0.05), mean blood loss (p< 0.05), mean duration of hospital stay (p< 0.05) and duration of catherization (p< 0.05) between the 3 groups as the series progressed. The two most important factors predictive of positive surgical margins at LRP were the initial PSA and tumour stage at diagnosis. The overall positive margin rate was 27.7%. For pT2 tumours the positive margin rate was 21% while patients with pT3 tumours had a positive margin of 44%. For pT2 tumours positive margin rates decreased with increasing experience (Group 1 27% vs Group 2 17% vs Group 3 19%). The incidence of major complications i.e. Grade CDS score ≤ III was 4.6% (14/300).
Conclusion: LRP is a safe procedure with low morbidity. As surgeons progress through the learning curve peri-operative parameters and oncological outcomes improve. Using a carefully mentored approach, LRP can be safely introduced as a new procedure without compromising patient outcomes.
Written by:
Vasdev N, Kass-Iliyya A, Patel A, Bedford G, O'Riordon A, Johnson M, Durkan G, Soomro NA. Are you the author?
Freeman Hospital, Urology, High Heaton, Newcastle upon Tyne, Tyne and Wear, United Kingdom, NE7 7DN.
Reference: J Endourol. 2012 Jan 19. Epub ahead of print.
doi: 10.1089/end.2011.0635
PubMed Abstract
PMID: 22260740
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