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 Amputees can learn to control a robotic arm with their minds
28.11.2017 | University of Chicago Medical Center

nachricht The importance of biodiversity in forests could increase due to climate change
17.11.2017 | Deutsches Zentrum für integrative Biodiversitätsforschung (iDiv) Halle-Jena-Leipzig

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: First-of-its-kind chemical oscillator offers new level of molecular control

DNA molecules that follow specific instructions could offer more precise molecular control of synthetic chemical systems, a discovery that opens the door for engineers to create molecular machines with new and complex behaviors.

Researchers have created chemical amplifiers and a chemical oscillator using a systematic method that has the potential to embed sophisticated circuit...

Im Focus: Long-lived storage of a photonic qubit for worldwide teleportation

MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.

Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...

Im Focus: Electromagnetic water cloak eliminates drag and wake

Detailed calculations show water cloaks are feasible with today's technology

Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...

Im Focus: Scientists channel graphene to understand filtration and ion transport into cells

Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.

To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...

Im Focus: Towards data storage at the single molecule level

The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.

Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

AKL’18: The opportunities and challenges of digitalization in the laser industry

07.12.2017 | Event News

 
Latest News

Engineers program tiny robots to move, think like insects

15.12.2017 | Power and Electrical Engineering

One in 5 materials chemistry papers may be wrong, study suggests

15.12.2017 | Materials Sciences

New antbird species discovered in Peru by LSU ornithologists

15.12.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>