The Learning Curve Analysis of Laparoscopic Radical Prostatectomy: Comparison with Retropubic Radical Prostatectomy

Min Yong Kang; Ja Hyun Ku; Cheol Kwak; Hyeon Hoe Kim

doi:10.4111/kju.2008.49.1.18

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Kang, Ku, Kwak, and Kim: The Learning Curve Analysis of Laparoscopic Radical Prostatectomy: Comparison with Retropubic Radical Prostatectomy

Original Article

Korean J Urol 2008;49(1):18-23.

Published online: 20 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.1.18

The Learning Curve Analysis of Laparoscopic Radical Prostatectomy: Comparison with Retropubic Radical Prostatectomy

Min Yong Kang, Ja Hyun Ku, Cheol Kwak, Hyeon Hoe Kim

From the Department of Urology, Seoul National University College of Medicine, Seoul, Korea

Received 21 August 2007 Revised 3 December 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We wanted to compare the early outcome of laparoscopic radical prostatectomy (LRP) as performed by a laparoscopic surgeon without experience with retropubic prostatectomy (RRP), and open RRP as performed by an oncologic surgeon without experience with LRP.

Materials and Methods

We reviewed the clinical data on the initial 31 LRPs (group 1) and the 107 RRPs (group 2), as performed by two surgeons at our institution. The two different surgeons performed each type of operation, respectively. Although each surgeon was an expert of laparo-scopic surgery and open surgery respectively, they were unfamiliar with radical prostatectomy.

Results

The mean operation time was longer in group 1 than in group 2 (303 minutes vs. 207 minutes, respectively, p＜0.001). However, the estimated mean blood loss (685ml vs. 1,488.0ml, respectively, p＜0.05) and the transfusion rate (24.1% vs. 55%, respectively, p＜0.05) were significantly less in group 1. The mean duration of the hospital stay, the days to oral feeding, the duration of analgesics use and the duration of an indwelling drain were similar between the two groups. The complication rate also did not differ significantly between the two groups (27.6% vs. 23.6%, respectively, p＞0.05), and no conversions or re-explorations were required and rectal injury did not occur in group 1. The histopathologic parameters of the two groups were comparable, especially in terms of the surgical margin positivity (37.9% vs. 43.4%, respectively, p>0.05). The continence rate and potency rate were also comparable between the two groups.

Conclusions

Our findings suggest that early outcome of LRP is comparable to that of RRP. Especially the estimated blood loss and the rate of transfusions were lower in the LRP group. We believe that the surgical outcome of LRP will continue to improve at specialized centers as laparo-scopic urologists gain experience, and even though an expert laparoscopic urologist may be a naïve for prostate cancer surgery, the learning curve is overcome earlier than expected.

Keywords: Laparoscopy, Prostatectomy, Learning curve, Outcome measures

References

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Fig. 1.

Learning curve analysis of LRP and RRP. LRP: laparo-scopic radical prostatectomy, RRP: retropubic prostatectomy.

Table 1.

Patient characteristics

	LRP	RRP	p-value
No. of patients	29	105
Mean age (years)	65.7±6.0	67.3±6.5	0.225∗
Mean body mass index	24.0±2.6	24.0±2.7	0.926∗
ASA performance status (1/2/3)	14/15/0	36/64/6	0.203^†
Preoperative prostate-specific antigen (ng/ml)	7.6±5.0	11.3±12.1	0.014∗
Clinical stage (%)∗			＜0.001^†
T1c	15 (51.7)	70 (66.6)
T2	11 (37.9)	15 (14.2)
T3a	0 (0)	21 (19.8)
T3b	3 (10.3)	0 (0)
Mean biopsy Gleason score	6.5±0.7	6.9±1.0	0.046∗

^∗ : Student's t-test,

^† : chi-square test, LRP: laparoscopic radical prostatectomy, RRP: retropubic prostatectomy, ASA: American Society of Anesthesiologists

Table 2.

Surgical outcomes

	LRP	RRP	p-value
Operation time (minutes)	303±106	207±62	＜0.001∗
Estimated blood loss (ml)	685±413	1488±1182	＜0.001∗
Transfusion rate (%)	7 (24.1)	58 (55)	＜0.001^†
Patient control anesthesia duration (days)	3.3±1.0	3.6±1.3	0.231∗
Postoperative hospital stay (days)	6.8±7.3	7.4±3.0	0.522∗
Resumption of oral intake (days)	1.5±0.8	1.2±0.8	0.079∗
Foley catheter indwelling (days)	15.7±8.9	11.8±6.4	0.010∗
Complications (%)	8 (27.6)	25 (23.6)	0.657^†

^∗ : Student's t-test,

^† : chi-square test, LRP: laparoscopic radica prostatectomy, RRP: retropubic prostatectomy

Table 3.

Histopathological outcomes

	LRP	RRP	p-value
T stage (%)			0.015^†
0	0 (0)	2 (1.9)
2a	5 (17.2)	21 (19.8)
2b	3 (10.3)	0 (0)
2c	12 (41.4)	45 (42.5)
3a	8 (27.6)	23 (21.7)
3b	1 (3.4)	15 (14.2)
Mean pathologic
Gleason score	6.7±0.8	6.9±1.0	0.311∗
Margin (%)
Negative	18 (62.1)	60 (56.6)	0.597^‡
Positive	11 (37.9)	46 (43.4)

^∗ : Student's t-test,

^† : Fisher's exact test,

^‡ : chi-square test, LRP: laparoscopic radical prostatectomy, RRP: retropubic prostatectomy

Table 4.

Functional outcomes

	Months	LRP	RRP	p-value
Continence rate (%)	3	62	67.8	0.527∗
	6	76.5	76.1
	12	82	95.8
Potency rate (%)	3	0	3.7	0.231∗
	6	7.7	13.3
	12	14.4	26

^∗ : Fisher's exact test, LRP: laparoscopic radical prostatectomy, RRP: retropubic prostatectomy

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