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Surgeon Experience Affects Outcomes After Laparoscopy

Learning curve slower for laparoscopic prostatectomy compared with open surgery

WEDNESDAY, April 1 (HealthDay News) -- Among prostate cancer surgery patients, lower recurrence rates have been found among those whose surgeon has performed more laparoscopic prostatectomies than among patients with low-volume surgeons, but the learning curve for laparoscopic prostatectomy is slower than for open surgery, according to a report published online April 1 in The Lancet Oncology.

Andrew J. Vickers, from Memorial Sloan-Kettering Cancer Center in New York City, and colleagues retrospectively examined the association between surgeon experience at the time of laparoscopic radical prostatectomy and prostate recurrence based on data from 29 surgeons and 4,702 prostate cancer patients.

After adjusting for case mix and established predictors, the researchers found that the risk of recurrence was significantly lower for surgeons with greater experience, with a five-year recurrence rate of 9 percent for patients whose surgeon had performed 750 procedures compared with a recurrence rate of 17 percent for patients whose surgeon had performed only 10 procedures. However, the learning curve was slower compared with a previous study that had reported large falls in recurrence rates after open radical prostatectomy with greater surgeon experience. Prior experience performing open surgery was associated with poorer results, with a risk difference of 12.3 percent compared with surgeons whose first operation was laparoscopic, the report indicates.

"Increasing surgical experience is associated with substantial reductions in cancer recurrence after laparoscopic radical prostatectomy, but improvements in outcome seem to accrue more slowly than for open surgery," Vickers and colleagues conclude. "Laparoscopic radical prostatectomy seems to involve skills that do not translate well from open radical prostatectomy."

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