Journal List > Korean J Urol > v.49(10) > 1005198

Kim, Hong, and Hwang: Laparoscopic Radical Prostatectomy: the Learning Curve of the Initial 150 Cases

Abstract

Purpose

We evaluated the early results and the learning curve of laparoscopic radical prostatectomy in the first 150 patients.

Materials and Methods

Between July 2001 and March 2007, 150 consecutive patients with clinically organ-confined prostate cancer underwent laparoscopic radical prostatectomy. For evaluation of the learning curve, morbidity, oncologic, and functional results of the first 50 (group 1) and last 50 (group 3) procedures were compared.

Results

The mean operating time and hospital stay was 289±66 minutes and 6.3±2.9 days, respectively. The median postoperative period of an indwelling Foley catheter was 5 days (range, 3-46 days). The intraoperative complication rate, including transfusion, was 15.3%. A positive surgical margin rate was 37.3%. After a mean follow-up of 33.5 months, a PSA relapse was observed in 39 (33.6%) patients. The continence rate was 77.1, 92.2, and 93.7% at 1, 6, and 12 months. Analysis of the learning curve revealed significant differences in the operating time, hospital stay, intraoperative complication rate, and indwelling Foley catheter days, whereas the postoperative complication rate, mean estimated blood loss, positive surgical margin rate, and continence rate 6 months postoperatively showed no influence.

Conclusions

Although laparoscopic radical prostatectomy requires significant expertise with a learning curve, the morbidity is low and the oncologic continence result was promising. The learning curve for laparoscopic radical prostatectomy depends not only on the technical skills, but also on the self-perceived definition. It is likely that no complete plateau of the learning curve exists for any article. Standardized expectations and reporting of outcomes could help to better define the true learning curve for laparoscopic radical prostatectomy.

Figures and Tables

Fig. 1
Legend duration of laparoscopic radical prostatectomy without pelvic lymph node dissection (A), with pelvic lymph node dissection (LND) (B).
kju-49-879-g001
Table 1
Characteristics of patients
kju-49-879-i001

PSA: prostate-specific antigen

Table 2
Operative data on laparoscopic radical prostatectomy
kju-49-879-i002

*: Student's t-test, : chi-square test, PLND: pelvic lymph node dissection

Table 3
Postoperative course for laparoscopic radical prostatectomy
kju-49-879-i003

*: Student's t-test, : chi-square test

Table 4
Oncologic result for laparoscopic radical prostatectomy
kju-49-879-i004

*: chi-square test, PSA: prostate-specific antigen

Table 5
Continence result of laparoscopic radical prostatectomy
kju-49-879-i005

*: chi-square test

References

1. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997. 50:854–857.
2. Guillonneau B, Cathelineau X, Barret E, Rozet F, Vallancien G. Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations. Eur Urol. 1999. 36:14–20.
3. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol. 2000. 163:1643–1649.
4. Abbou CC, Salomon L, Hoznek A, Antiphon P, Cicco A, Saint F, et al. Laparoscopic radical prostatectomy: preliminary results. Urology. 2000. 55:630–634.
5. Raboy A, Ferzli G, Albert P. Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology. 1997. 50:849–853.
6. Jang J, Cha SH, Kim DB, Kim JC, Hwang TK. Laparoscopic radical prostatectomy. Korean J Urol. 2002. 43:342–345.
7. Lu-Yao GL, Albertsen P, Warren J, Yao SL. Effect of age and surgical approach on complications and short-term mortality after radical prostatectomy-a population-based study. Urology. 1999. 54:301–307.
8. Ghavamian R, Knoll A, Boczko J, Melman A. Comparison of operative and functional outcomes of laparoscopic radical prostatectomy and radical retropubic prostatectomy: single surgeon experience. Urology. 2006. 67:1241–1246.
9. Ho SF, Lao HF, Li K, Tse MK. Clinical results of radical prostatectomy for patients with prostate cancer in Macau. Chin Med J (Engl). 2008. 121:295–298.
10. Alibhai SM, Leach M, Tomlinson G. Impact of hospital and surgeon volume on mortality and complications after prostatectomy. J Urol. 2008. 180:155–162.
11. Liatsikos EN, Assimakopoulos K, Stolzenburg JU. Quality of life after radical prostatectomy. Urol Int. 2008. 80:226–230.
12. Weldon VE, Tavel FR, Neuwirth H. Continence, potency and morbidity after radical perineal prostatectomy. J Urol. 1997. 158:1470–1475.
13. Boccon-Gibod L, Ravery V, Vordos D, Toublanc M, Delmas V, Boccon-Gibod L. Radical prostatectomy for prostate cancer: the perineal approach increases the risk of surgically induced positive margins and capsular incisions. J Urol. 1998. 160:1383–1385.
14. May M, Dorst M, May J, Hoschke B, Fahlenkamp D, Vogler H, et al. Radical retropubic vs. radical perineal prostatectomy: a comparison of relative benefits in four urban hospitals. Urol Nurs. 2007. 27:519–526.
15. Kang MY, Ku JH, Kwak C, Kim HH. The learning curve analysis of laparoscopic radical prostatectomy: comparison with retropubic radical prostatectomy. Korean J Urol. 2008. 49:18–23.
16. Bollens R, Sandhu S, Roumeguere T, Quackels T, Schulman C. Laparoscopic radical prostatectomy: the learning curve. Curr Opin Urol. 2005. 15:79–82.
17. Kim YJ, Han BK, Byun SS, Lee SE. Comparison of perioperative outcomes of extraperitoneal laparoscopic radical prostatectomy (ELRP) versus open radical retropubic prostatectomy (RRP): single surgeon's initial experience. Korean J Urol. 2007. 48:131–137.
18. Gaylis FD, Friedel WE, Armas OA. Radical retropubic prostatectomy outcomes at a community hospital. J Urol. 1998. 159:167–171.
19. Nadu A, Salomon L, Hoznek A, Olsson LE, Saint F, de La Taille A, et al. Early removal of the catheter after laparoscopic radical prostatectomy. J Urol. 2001. 166:1662–1664.
20. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations. Prostate. 1999. 39:71–75.
21. Cho KS, Hong SJ, Chung BH. The impact of positive surgical margins on biochemical recurrence after radical retropubic prostatectomy. Korean J Urol. 2004. 45:416–422.
22. Ohori M, Wheeler TM, Kattan MW, Goto Y, Scardino PT. Prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol. 1995. 154:1818–1824.
23. Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol. 2002. 167:51–56.
24. Terakawa T, Miyake H, Tanaka K, Takenaka A, Inoue TA, Fujisawa M. Surgical margin status of open versus laparoscopic radical prostatectomy specimens. Int J Urol. 2008. 15:704–707.
25. Guillonneau B, Cathelineau X, Doublet J, Baumert H, Vallancien G. Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol. 2002. 43:123–133.
26. Touijer K, Eastham JA, Secin FP, Romero Otero J, Serio A, Stasi J, et al. Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in 2003 to 2005. J Urol. 2008. 179:1811–1817.
27. Walsh PC, Marschke P, Ricker D, Burnett AL. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology. 2000. 55:58–61.
TOOLS
Similar articles