Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Outcome of prostate cancer surgery depends on the experience of the surgeon

25.07.2007
Steep learning curve found

According to a new study published online today in the Journal of the National Cancer Institute, prostate cancer patients treated by highly experienced surgeons are much more likely to be cancer-free five years after surgery than patients treated by surgeons with less experience.

“The difference in outcome among patients who were treated by surgeons with varying degrees of experience is clinically relevant and likely reflects a true relationship between surgical technique and cancer control,” said the study’s lead author Andrew Vickers, PhD, Associate Attending Research Methodologist, Memorial Sloan-Kettering Cancer Center (MSKCC).

Many studies have examined the relationship between surgical experience and patient outcomes. However, it is often unclear whether the findings are related to differences in surgical technique or result from differences in clinical variables or tumor characteristics. In the current study, the researchers adjusted for cancer severity, so that differences among surgeons likely reflect differences in the techniques they use rather than just differences in the patients they see.

Investigators analyzed the cancer outcomes of 7,765 prostate cancer patients who were treated with radical prostatectomy – surgical removal of the prostate – by one of 72 surgeons at four major US academic medical centers over a 16-year period. Sophisticated statistical models were used to evaluate the link between the total number of prostatectomies performed by the surgeon prior to each patient's operation and biochemical recurrence of prostate cancer (defined as a rising PSA level of more than 0.4 ng/mL).

The results showed that the risk of recurrence five years after surgery was 17.9 percent for patients treated by surgeons who had performed 10 operations and 10.7 percent for patients treated by surgeons who had performed 250 operations. This means that patients treated by inexperienced surgeons were nearly 70 percent more likely to have a recurrence of their prostate cancer than those who were treated by surgeons with greater experience. According to the analysis, one out of every 14 patients treated by an inexperienced surgeon will have a recurrence.

The results were described in terms of a learning curve, which showed a dramatic improvement in cancer control with increasing surgical experience up to 250 prior operations; however, there was no large change in recurrence rates with additional surgical experience.

“The learning curve is steep and did not start to plateau until a surgeon had completed 250 prior operations,” said the study’s senior author, Peter Scardino, MD, Chairman, Department of Surgery, MSKCC. “Surgeons with little experience get significantly poorer results than those who have more.”

“Our results provide support for what other studies have implied – that good technique is learned and increased volume leads to improved outcomes,” said Dr. Vickers. “However, our focus on cancer outcome, the size of the difference in outcome associated with increasing surgical experience, and the large number of cases required before the learning curve starts to plateau, suggests that more serious attention should be paid to the issue of surgical quality.”

The researchers note that the surgical technique of experienced surgeons may differ from that of surgeons with less experience. They conclude that further research is needed to determine how surgical technique might differ between these groups and to identify the critical aspects of radical prostatectomy that are associated with improved cancer control.

“Although the successful practice of surgery presumes a lifetime of learning, the large number of cases required before the learning curve plateaus suggests the need to expand opportunities for training in surgical technique for surgeons in the early years after residency training,” said Dr. Scardino.

Esther Napolitano | EurekAlert!
Further information:
http://www.mskcc.org

More articles from Studies and Analyses:

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Ocean atmosphere rife with microbes

17.10.2017 | Life Sciences

Neutrons observe vitamin B6-dependent enzyme activity useful for drug development

17.10.2017 | Life Sciences

NASA finds newly formed tropical storm lan over open waters

17.10.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>