Is the Surgeon Experience the Most Important Prognostic factor?: A Review of the Outcome of 648 Open Radical Prostatectomies by the Same Surgical Team in Private Practice
Abstract:
Introduction and Objectives: Radical prostatectomy (RP) remains as the gold standard treatment for localized prostate cancer, whether it’s open (ORP) or robotic surgery (RS). There are several studies comparing these two modalities, and most of them conclude that the surgical and oncological outcomes are equal; leading us to a debate: which surgical modality is the best for the patient? The objective of this study is to demonstrate how the surgeon’s experience can become the best prognostic factor regardless of the surgical approach.
Materials and Methods: We analyzed 648 cases of open radical prostatectomy (ORP) with bilateral lymph node dissection done by the same surgeon and surgical team in a private practice basis, performed from 1991 to 2022. There were no limitations on age: our youngest patient was 40 years old and the oldest 87. All patients underwent a pre-operative assessment by an anesthesiologist. All surgeries were performed under spinal blockage. For the analysis of the cases, the patients were divided in four groups of 162 surgeries each one. The surgical outcome was evaluated by measuring the following factors: surgical time (ST), bleeding amount (BA), mortality (MT), use of intensive care unit (ICU), incontinence (ICT), erectile dysfunction (ED) and hospitalization time (HT).
Results: The overall surgical outcome results are: MT 0%, ICU 0%, BA 508 mL, HT 2.9 days, ED 18.45%, ICT 0.4%. The improvement on the surgical outcome from Group 1 to group 4 were the following: ST 36.5%, HT 21.9%, BA 21.3%, ED 10%, ICT 1.2%. ICU and MT show no improvement because they remained at 0%. The results of the análisis are shown in Table 1.
Conclusion: Our data show that there’s an evident improvement on the surgery outcome directly related to the number of surgeries performed by the surgeon; thus confirming to us that the surgeon experience should be considered one of the most important prognostic factors in RP, regardless if it’s ORP or RS.
