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!
Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung
Scientists reveal source of human heartbeat in 3-D
07.08.2017 | University of Manchester
Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.
As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...
Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.
Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...
For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.
While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...
An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.
The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...
A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.
Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...
16.08.2017 | Event News
04.08.2017 | Event News
26.07.2017 | Event News
17.08.2017 | Physics and Astronomy
17.08.2017 | Earth Sciences
17.08.2017 | Physics and Astronomy