The Australian laparoscopic radical prostatectomy learning curve

International estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship-trained Australian surgeons.

Prospectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n = 900) were compared to their second 100 cases (S100, n = 782) with two of nine surgeons completing fewer than 200 cases.

The mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high-, intermediate- and low-risk cases were 15, 59 and 26% for the F100 versus 20, 59 and 21% for the S100, respectively. Blood transfusions (2.4 versus 0.8%), mean blood loss (413 versus 378 mL), mean operating time (193 versus 163 min) and length of stay (2.7 versus 2.4 days) were all lower in the S100. Histopathology was organ confined (pT2) in 76% of F100 and 71% of S100. Positive surgical margin (PSM) rate was 18.4% in F100 versus 17.5% in the S100 (P = 0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5% (P = 0.13), pT3a PSM 34.8 versus 40.5% (P = 0.29) and pT3b PSM 52.9 versus 36.4% (P = 0.14).

There was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.

ANZ journal of surgery. 2017 May 16 [Epub ahead of print]

Marcus Handmer, Charles Chabert, Ronald Cohen, Troy Gianduzzo, Paul Kearns, Daniel Moon, Jason Ooi, Tom Shannon, David Sofield, Andrew Tan, Mark Louie-Johnsun

Department of Urology, The University of Newcastle, Gosford Hospital, Gosford, New South Wales, Australia., Department of Urology, Pindara Gold Coast Private Hospital, Gold Coast, Queensland, Australia., Department of Pathology, Uropath Pty Ltd, Perth, Western Australia, Australia., School of Medicine, University of Queensland, Brisbane, Queensland, Australia., Department of Urology, Geelong Hospital, Geelong, Victoria, Australia., Department of Urology, Epworth HealthCare, Melbourne, Victoria, Australia., Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia., Department of Urology, Hollywood Private Hospital, Nedlands, Western Australia, Australia., Department of Urology, Bethesda Hospital, Perth, Western Australia, Australia., Department of Urology, Royal Perth Hospital, Perth, Western Australia, Australia.