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2008 Annual Meeting Abstracts
Achieving Oncologic Competency With Robotic Prostatectomy: Can A Community Urologist Without Fellowship Training Achieve Optimal Results?
Douglas E Sutherland, Fernando J. Bianco, Jr, Song Hau Tran*, Jason D. Engel
George Washington University, Washington, DC
Introduction: We reviewed the robotic prostatectomy (RAP) series of a community urologist without fellowship training or extensive open prostatectomy experience. We attempted to determine when oncologic competency was achieved.
Methods: All RAP procedures performed between January, 2004 and December, 2007, by a single surgeon (JDE), were reviewed for positive surgical margins (PSM) and biochemical recurrence (BCR). Logarithmic regression was used to determine if clinical variables and surgeon experience could predict risk of PSM.
Results: A total of 469 consecutive patients underwent RAP. The overall, pT2, and pT3 PSM rates were 23.9%, 20.5%, and 39.6%, respectively. Preoperative PSA was the only clinical variable that predicted PSM (p= 0.001). Pathologic stage first predicted PSM during the 4th year, after 290 patients had been treated (p< 0.0001). The incidence of PSM dropped with surgeon experience despite a negative trend in preoperative risk group stratification. The effect of surgeon experience on risk of PSM failed to achieve statistical significance at this time (ROC area = 0.530), but a downward trend was observed. PSM was strongly associated with BCR (p= 0.001). The overall freedom from BCR was 72%, 78% if the surgical margin was negative, and 57% if positive (p< 0.05). For pT2 patients, freedom from BCR was 93% if the surgical margin was negative compared to 67% if it was positive (p< 0.05).
Conclusions: The predicted probability of PSM dropped with surgeon experience, and the risk of PSM correlates significantly with preoperative PSA and pathological stage. A PSM strongly predicts BCR.
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