The surgical learning curve for positive surgical margins after robot-assisted radical prostatectomy: Results from a multi-institutional collaboration

You have accessJournal of UrologyCME1 Apr 2023MP80-01 THE SURGICAL LEARNING CURVE FOR POSITIVE SURGICAL MARGINS AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: RESULTS FROM A MULTI-INSTITUTIONAL COLLABORATION Carlo Bravi, Paolo Dall'Oglio, Elio Mazzone, Ruben De Groote, Aalst Belgium, Ugo Falagario, Riccardo Schiavina, Pietro Piazza, Marco Borghesi, Simone Scarcella, Marcio Covas Moschovas, Filippo Turri, Iulia Andras, Cluj-Napoca Romania, Fabrizio Di Maida, Giuseppe Carrieri, Carlo Terrone, Riccardo Autorino, Vipul Patel, Francesco Porpiglia, Aldo Bocciardi, Andrea Minervini, Francesco Montorsi, Koon Ho Rha, and Alexandre Mottrie Carlo BraviCarlo Bravi More articles by this author , Paolo Dall'OglioPaolo Dall'Oglio More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Aalst BelgiumAalst Belgium More articles by this author , Ugo FalagarioUgo Falagario More articles by this author , Riccardo SchiavinaRiccardo Schiavina More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Marco BorghesiMarco Borghesi More articles by this author , Simone ScarcellaSimone Scarcella More articles by this author , Marcio Covas MoschovasMarcio Covas Moschovas More articles by this author , Filippo TurriFilippo Turri More articles by this author , Iulia AndrasIulia Andras More articles by this author , Cluj-Napoca RomaniaCluj-Napoca Romania More articles by this author , Fabrizio Di MaidaFabrizio Di Maida More articles by this author , Giuseppe CarrieriGiuseppe Carrieri More articles by this author , Carlo TerroneCarlo Terrone More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Vipul PatelVipul Patel More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Aldo BocciardiAldo Bocciardi More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Koon Ho RhaKoon Ho Rha More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In our preliminary single center experience, we described a learning curve for positive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP). Now, we aim to characterize the learning curve for PSM after RARP in a multi-institutional collaboration. METHODS: We analyzed data of 15,167 patients with prostate cancer treated with RARP by one of 83 surgeons at 14 institutions between 2003 and 2022. Multivariable models assessed the association between surgeon experience (number of RARPs done by the surgeon before the index patient’s operation) and PSM after surgery, with adjustment for preoperative PSA level, grade, stage, and year of surgery. RESULTS: Median (interquartile range) PSA at surgery was 6.7 (5.0, 9.9) ng/ml. A total of 4,937 (33%), 2,404 (16%) and 938 (6%) patients had extra-capsular extension, International Society of Urologic Pathology group ≥4, and lymph node involvement on final pathology, respectively. Overall, 3,736 (25%) men had PSM at final pathology. After adjusting for case mix, we found a significant association between surgical experience and probability of PSM after surgery, with lower risk of PSM for greater surgeon experience (p=0.002; Figure 1). The probability of PSM for a patient treated by a surgeon with 10, 1000 and 2000 prior robotic procedures was 25.9% (95% confidence interval [CI]: 25.2%, 27.4%), 21.7% (95%CI: 20.6%, 22.3%) and 18% (95%CI: 16.1%, 18.6%), respectively (absolute risk difference between 10 and 2000 procedures: 7.86%; 95%CI: 6.9%, 10.7%). Results were unaltered after excluding surgeons with less than 100 prior RARPs performed at index patient’s operation (p=0.004), and repeating the analyses only including patients operated by surgeons who had performed fewer than 500 RARPs (p=0.023). CONCLUSIONS: In the largest series of patients exploring the association between surgical experience and risk of PSM after RARP, we confirmed our prior finding of a learning curve for PSM after RARP, with increasing prior experience associated with lower rate of PSM. Future investigations should now focus on what exactly more experienced surgeons do to avoid positive margins as compared to surgeons at an earlier stage of their career. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1151 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlo Bravi More articles by this author Paolo Dall'Oglio More articles by this author Elio Mazzone More articles by this author Ruben De Groote More articles by this author Aalst Belgium More articles by this author Ugo Falagario More articles by this author Riccardo Schiavina More articles by this author Pietro Piazza More articles by this author Marco Borghesi More articles by this author Simone Scarcella More articles by this author Marcio Covas Moschovas More articles by this author Filippo Turri More articles by this author Iulia Andras More articles by this author Cluj-Napoca Romania More articles by this author Fabrizio Di Maida More articles by this author Giuseppe Carrieri More articles by this author Carlo Terrone More articles by this author Riccardo Autorino More articles by this author Vipul Patel More articles by this author Francesco Porpiglia More articles by this author Aldo Bocciardi More articles by this author Andrea Minervini More articles by this author Francesco Montorsi More articles by this author Koon Ho Rha More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...