MP15-12 THE IMPACT OF SURGICAL CASELOAD VOLUME ON QUALITY OF LIFE IN MEN AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2014MP15-12 THE IMPACT OF SURGICAL CASELOAD VOLUME ON QUALITY OF LIFE IN MEN AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Brian Kim, Madhur Merchant, Jeff Slezak, Kimberly Porter, Joy Gelfond, Steven J. Jacobsen, and Gary W. Chien Brian KimBrian Kim More articles by this author , Madhur MerchantMadhur Merchant More articles by this author , Jeff SlezakJeff Slezak More articles by this author , Kimberly PorterKimberly Porter More articles by this author , Joy GelfondJoy Gelfond More articles by this author , Steven J. JacobsenSteven J. Jacobsen More articles by this author , and Gary W. ChienGary W. Chien More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.565AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Increased robotic surgical volumes correlate to better peri-operative outcomes, such as reduced positive surgical margin rates (PSMRs). The impact of surgeon experience on long-term cancer-specific and functional outcomes is less evident. The study objective was to evaluate whether caseload volume for robot-assisted radical prostatectomy (RARP) impacts quality of life in prostate cancer patients. METHODS From March 2011 to September 2013, we enrolled men who underwent a RARP within the Kaiser Permanente Southern California Healthcare system. All surgeons with robotic privileges had undergone a rigorous credentialing process and had extensive training in robotics in fellowship and/or residency. Patients completed the Expanded Prostate Cancer Index Composite (EPIC)-26, a validated quality of life survey, at baseline (time of diagnosis) and at 1, 3, 6, 12, 18, and 24 months following surgery. EPIC-26 scores were then compared between "low-volume" surgeons (who completed <100 career RARPs) and “high-volume” surgeons (who completed ≥100 career RARPs) using the Chi-squared and Wilcoxon Rank-Sum tests. RARPs were performed using a standard 6-port transperitoneal approach with one console surgeon and one assistant surgeon. RESULTS A total of 1675 men underwent a RARP during the study period. Fifteen low- and 10 high-volume urologists performed 1082 and 593 RARPs respectively as the console surgeon. The average number of RARPs performed was 15.9 in the low- and 146.7 in the high-volume groups. High-volume surgeons assisted the majority of low-volume surgeons in their respective cases. Patients were similar in clinico-pathological traits, apart from older men in the high-volume group (61.3 vs. 60.8 years, p=0.035). High-volume group patients had less intra-operative blood loss (97.0 vs 136.8 mL, p<0.0001) and underwent more bladder-neck reconstructions (253 vs. 237 cases, p<0.0001). PSMRs were similar for high- and low-volume surgeons (21.3% vs. 24.4%, p=0.2). There were no differences in EPIC-26 scores thoughout the entire 24-month follow-up period. CONCLUSIONS Surgical volume did not appear to impact quality of life in men who underwent RARP after 2 years follow-up. In our robotics program, high-volume surgeons may have acted as proctors in low-volume surgeons' cases, positively influencing peri-operative and long-term outcomes. These results support the benefit of having experienced assistants, in order to assure equal outcomes, not at the expense of excluding lower-volume credentialed surgeons. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e149-e150 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Brian Kim More articles by this author Madhur Merchant More articles by this author Jeff Slezak More articles by this author Kimberly Porter More articles by this author Joy Gelfond More articles by this author Steven J. Jacobsen More articles by this author Gary W. Chien More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...