The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy： experience of a single surgeon with 500 cases in Taiwan, China  

机器人辅助腹腔镜根治前列腺切除术的外科学习曲线：一名外科医生500病例的经验

作　　者：Yen-Chuan OU Chun-Kuang Yang Kuangh-Si Chang John Wang Siu-Wan Hung Min-Che Tung Ashutosh K Tewari Vipul R Patel 

机构地区：[1]Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, China [2]School of Medicine, National Yang-Ming University, Taipei, Taiwan, China [3]Department of Research, Taichung Veterans General Hospital, Taichung, Taiwan, China [4]Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan, China [5]Department of Radiation, Taichung Veterans General Hospital, Taichung, Taiwan, China [6]Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospita Taichung, Taiwan, China [7]New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA [8]Global Robotics Institute, Florida Hospital, Orlando, Florida, USA,

出　　处：《Asian Journal of Andrology》2014年第5期728-734,I0009,共8页亚洲男性学杂志（英文版）

摘　　要：To analyze the learning curve for cancer control from an initial 250 cases （Group I） and subsequent 250 cases （Group II） of robotic-assisted laparoscopic radical prostatectomy （RALP） performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups, Positive surgical margin （PSM） and biochemical recurrence （BCR） were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I （22.2% vs 14.2%, respectively, with Gleason score 8-10, P = 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P = 0.017）. The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group Ih A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle （NVB） preservation was significantly influenced by the PSM in high-risk patients （84.1% in the preservation group vs 43.9% in the nonpreservation group）. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.To analyze the learning curve for cancer control from an initial 250 cases （Group I） and subsequent 250 cases （Group II） of robotic-assisted laparoscopic radical prostatectomy （RALP） performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups, Positive surgical margin （PSM） and biochemical recurrence （BCR） were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I （22.2% vs 14.2%, respectively, with Gleason score 8-10, P = 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P = 0.017）. The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group Ih A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle （NVB） preservation was significantly influenced by the PSM in high-risk patients （84.1% in the preservation group vs 43.9% in the nonpreservation group）. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.

关 键 词：cancer control learning curve prostate cancer prostatectomy ROBOTICS surgical margin 

分 类 号：R[医药卫生]