Experience Critical When Choosing Prostatectomy Surgeon

It seems like common sense to say that a surgeon with more experience will achieve better results. It's a statement that's also backed up by medical research conducted by the Journal of the National Cancer Institute and the Journal of Urology. Looking specifically at robotic prostatectomies, the data shows that:

"...a typical patient undergoing RP with a surgeon who reached a learning curve plateau of 250 prior RPs had a 10.9% risk of recurrence at five years compared with a 17.7% rate for men treated by a surgeon who had performed only 10 such procedures previously."

So, basically this means that you are at a 70% higher risk for a return of your prostate cancer if your robotic prostatectomy (RP) is performed by an inexperienced surgeon.

How did the Journal of the National Cancer Institute settle on 250 RPs as the dividing line between experienced and inexperienced surgeons? Well, surgeons performing less than that number of RPs continued to generate lower and lower rates of recurrence as they got more operations under their belt, but at about the 250 RP mark the rates of recurrence start to flatten out. Thus, 250 RPs seems to be more or less the point when a surgeon can be said to have "mastered" the robotic prostatectomy.

There is one problem, though:

"Few surgeons, however, perform anywhere near this many RPs in the course of their career. In fact, in a study published recently in the Journal of Urology (2009;182:2677-2681), Dr. Vickers and an MSCCC colleague, Caroline J. Savage, MPH, found that 82.9% of 933 surgeons surveyed perform 10 or fewer RPs per year."

So while it might be tough to find an experienced prostatectomy surgeon, doing your homework is worth the effort. The Journal of Urology recommends finding a specialist. In fact, they recommend specialization in general when it comes to complicated robotic surgery. It's not the kind of thing that a doctor merely dabbles in:

“If you have fewer surgeons doing more cases, then you're going to have fewer surgeons and patients on the learning curve. Our data show that you have to be very experienced to be good at this operation, and that an awful lot of surgeons out there are just never going to be able to get sufficient levels of experience. So it seems reasonable to suppose that we should really have people who focus on this operation doing it.”

(h/t Renal & Urology News)