Abstract
Purpose
Laparoscopic radical prostatectomy (LRP) has a long learning curve; however, little is known about the pentafecta learning curve for LRP. We analysed the learning curve for a fellowship trained surgeon with regard to the pentafecta with up to 6-year follow-up.
Methods
A retrospective review was performed in 550 cases, by dividing these cases into 11 groups of 50 patients. Outcomes analysed were the following: (1) the pentafecta (complication rate, positive surgical margin (PSM) rate, continence, potency and biochemical recurrence); (2) operative time and blood loss; and (3) overall pentafecta attainment.
Results
The mean complication rate for the entire series was 9 %; this plateaued after 150 cases. The overall PSM rate for the series was 23.5 %, 16.3 % for pT2 and 40.5 % for pT3. PSM plateaued after 200 cases. Excluding the first 100 cases, the overall PSM rate for pT2 was 10.9 % and 37.8 % for pT3. The continence rate stabilised after approximately 250 cases. The rate of male sling/artificial urinary sphincter plateaued after 200 cases. The potency learning curve continues to improve after 250 cases of nerve-sparing (ns) endoscopic extraperitoneal radical prostatectomy (EERPE) as does the pentafecta learning curve which closely follows the pattern of the potency learning curve. The last group of nsEERPE achieved pentafecta in 63 %.
Conclusion
This study shows multiple learning curves: an initial for peri-operative outcomes, then stabilisation of oncologic outcomes and the final for stabilisation of functional outcomes. In this series over 250 cases were required to achieve the learning curve.
Similar content being viewed by others
References
Office of National Statistics 2012 Available from: http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations
Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V et al (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59(1):61–71
Rassweiler J, Stolzenburg J, Sulser T, Deger S, Zumbe J, Hofmockel G et al (2006) Laparoscopic radical prostatectomy—the experience of the German laparoscopic working Group. Eur Urol 49(1):113–119
Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M et al (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55(5):1037–1063
Laird ASG, Fowler S, McNeill SA (2012) The UK radical prostatectomy audit 2011. BJU Int 109(Supp 7):3
Patel VR, Sivaraman A, Coelho RF, Chauhan S, Palmer KJ, Orvieto MA et al (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59(5):702–707
Vasdev N, Kass-Iliyya A, Patel A, Bedford G, O’Riordon A, Johnson MI et al (2012) Developing a laparoscopic radical prostatectomy service: defining the learning curve. J Endourol 26(7):903–910
Secin FP, Savage C, Abbou C, de La Taille A, Salomon L, Rassweiler J et al (2010) The learning curve for laparoscopic radical prostatectomy: an international multicenter study. J Urol 184(6):2291–2296
Eden CG, Neill MG, Louie-Johnsun MW (2009) The first 1,000 cases of laparoscopic radical prostatectomy in the UK: evidence of multiple ‘learning curves’. BJU Int 103(9):1224–1230
Stolzenburg JUSH, Bhanot SM, Rabenalt R, Do M, Truss M, Ho K, Anderson C (2005) Modular surgical training for endoscopic extraperitoneal radical prostatectomy. BJU Int 96(7):1022–1027
Stolzenburg JURR, Do M, Schwalenberg T, Winkler M, Dietel A, Liatsikos E (2008) Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Eur Urol 53(5):931–940
Tewari AK, Ali A, Metgud S, Theckumparampil N, Srivastava A, Khani F et al (2013) Functional outcomes following robotic prostatectomy using athermal, traction free risk-stratified grades of nerve sparing. World J Urol 31(3):471–480
Stolzenburg JU, Kallidonis P, Minh D, Dietel A, Hafner T, Dimitriou D et al (2009) Endoscopic extraperitoneal radical prostatectomy: evolution of the technique and experience with 2,400 cases. J Endourol 23(9):1467–1472
Dindo DDN, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240(2):205–213
Ghavamian R, Schenk G, Hoenig DM, Williot P, Melman A (2004) Overcoming the steep learning curve of laparoscopic radical prostatectomy: single-surgeon experience. J Endourol 18(6):567–571
Poulakis V, Dillenburg W, Moeckel M, de Vries R, Witzsch U, Zumbe J et al (2005) Laparoscopic radical prostatectomy: prospective evaluation of the learning curve. Eur Urol 47(2):167–175
Hellawell GO, Moon DA (2008) Laparoscopic radical prostatectomy: reducing the learning curve. Urology 72(6):1347–1350
Sultan MF, Merrilees AD, Chabert CC, Eden CG (2009) Blood loss during laparoscopic radical prostatectomy. J Endourol 23(4):635–638
Hruza M, Weiss HO, Pini G, Goezen AS, Schulze M, Teber D et al (2010) Complications in 2,200 consecutive laparoscopic radical prostatectomies: standardised evaluation and analysis of learning curves. Eur Urol 58(5):733–741
Rodriguez AR, Rachna K, Pow-Sang JM (2010) Laparoscopic extraperitoneal radical prostatectomy: impact of the learning curve on perioperative outcomes and margin status. JSLS 14(1):6–13
Vickers AJ, Savage CJ, Hruza M, Tuerk I, Koenig P, Martinez-Pineiro L et al (2009) The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study. Lancet Oncol 10(5):475–480
Nicolosi A, Buvat J, Glasser DB, Hartmann U, Laumann EO, Gingell C (2006) Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviors. World J Urol 24(4):423–428
Asimakopoulos AD, Miano R, Di Lorenzo N, Spera E, Vespasiani G, Mugnier C (2013) Laparoscopic versus robot-assisted bilateral nerve-sparing radical prostatectomy: comparison of pentafecta rates for a single surgeon. Surg Endosc 27(11):4297–4304
Huang JL, Ma LL, Huang Y, Hou XF, Wang GL, Hong K et al (2012) Postoperative urinary continence and learning curve after laparoscopic radical prostatectomy. Beijing Da Xue Xue Bao 44(4):563–567
Sammon JD, Karakiewicz PI, Sun M, Sukumar S, Ravi P, Ghani KR, Bianchi M, Peabody JO, Shariat SF, Perrotte P, Hu JC, Menon M, Trinh QD (2013) Robot-assisted versus open radical prostatectomy: the differential effect of regionalization, procedure volume and operative approach. J Urol 189(4):1289–1294
Brown JA, Sajadi KP (2009) Laparoscopic radical prostatectomy: 6 months of fellowship training doesn’t prevent the learning curve when incorporating into a lower volume practice. Urol Oncol 27(2):144–148
Stolzenburg JU, Rabenalt R, Do M, Horn LC, Liatsikos EN (2006) Modular training for residents with no prior experience with open pelvic surgery in endoscopic extraperitoneal radical prostatectomy. Eur Urol 49(3):491–498 discussion 9–500
Mirheydar HS, Parsons JK (2012) Diffusion of robotics into clinical practice in the United States: process, patient safety, learning curves, and the public health. World J Urol 31(3):455–461
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Good, D.W., Stewart, G.D., Stolzenburg, J.U. et al. Analysis of the pentafecta learning curve for laparoscopic radical prostatectomy. World J Urol 32, 1225–1233 (2014). https://doi.org/10.1007/s00345-013-1198-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-013-1198-9