RARP Surgical Volume Has No Effect on Quality of Life
Study compared surgeons who performed fewer than 100 with those who performed 100 or more.
ORLANDO—Surgical volume does not impact long-term quality of life in prostate cancer patients who undergo robot-assisted radical prostatectomy (RARP), investigators reported at the American Urological Association annual meeting.
Brian J. Kim, MD, Kaiser Permanente Los Angeles Medical Center in Los Angeles, California, and colleagues compared long-term quality of life outcomes by robotic surgical caseload in men who underwent RARP over a recent 2.5-year period.
The procedures were performed at 13 Kaiser Permanente Southern California medical centers in standard 6-port transperitoneal fashion by 2 robotics-trained surgeons (1 primary console surgeon and 1 assistant surgeon). To have robotic privileges, the surgeons were required to undergo a rigorous credentialing process and comprehensive training in robotics during their fellowships and/or residencies.
Surgeons were defined as “low volume” if they had completed fewer than 100 RARPs during their career, whereas surgeons who had completed at least 100 RARPs were deemed “high volume.”
Patients completed the Expanded Prostate Cancer Index Composite (EPIC)-26 Questionnaire at baseline when they were initially diagnosed and again at 1, 3, 6, 12, 18, and 24 months after surgery. The widely validated questionnaire includes sexual, urinary irritative, urinary incontinence, bowel, and hormonal domains.
Overall, 1,660 men underwent a RARP during the study period. Fifteen low-volume and 10 high-volume urologists performed 820 and 840 RARPs, respectively. Patients in the 2 groups were similar in clinico-pathological traits and in pelvic lymph node dissection and nerve-sparing rates.
Bladder neck tailoring was performed significantly more frequently in the high-volume surgeon group (46.7% vs. 31.1%). Positive surgical margin rates were similar for high- and low-volume surgeons (21.3% vs. 24.4%).
The mean estimated blood loss was significantly less in the high-volume group patients (101.5 vs. 140.1 mL.
The study demonstated no differences in EPIC-26 scores throughout the entire 24-month follow-up period in any of the 5 domains.
Dr. Kim called the results “counterintuitive” and suggested that they may be due to the fact that high-volume surgeons may have acted as proctors in low-volume surgeons' cases, potentially negating the effect of surgeon experience.