Complications in 2200 Consecutive Laparoscopic Radical Prostatectomies: Standardised Evaluation and Analysis of Learning Curves

Abstract Background Laparoscopic radical prostatectomy (LRP) represents an established treatment modality for localised prostate cancer. Objective To report standardised complication rates for LRP, evaluate the development of complication rates over time, and show changes within the learning curves...

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Bibliographic Details
Published in:	European urology Vol. 58; no. 5; pp. 733 - 741
Main Authors:	Hruza, Marcel, Weiß, Hagen O, Pini, Giovannalberto, Goezen, Ali S, Schulze, Michael, Teber, Dogu, Rassweiler, Jens J
Format:	Journal Article
Language:	English
Published:	Kidlington Elsevier 01-11-2010
Subjects:	Aged Biological and medical sciences Education, Medical, Continuing - statistics & numerical data Follow-Up Studies General Surgery - education General Surgery - statistics & numerical data Gynecology. Andrology. Obstetrics Humans Laparoscopy - adverse effects Laparoscopy - education Laparoscopy - mortality Male Male genital diseases Medical sciences Middle Aged Nephrology. Urinary tract diseases Postoperative Complications - classification Postoperative Complications - mortality Postoperative Complications - pathology Predictive Value of Tests Prostatectomy - adverse effects Prostatectomy - education Prostatectomy - mortality Prostatic Neoplasms - mortality Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Tumors Tumors of the urinary system Urinary tract. Prostate gland Urology Prostatectomy Laparoscopy Clavien classification Complications Prostate cancer Endoscopic surgery Evaluation Nephrology Urinary system disease Prostate disease Standardization Curve Laparoscopic surgery Malignant tumor Urology Learning Acquisition process Treatment Classification Complication Endoscopy Male genital diseases Cancer
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Summary:	Abstract Background Laparoscopic radical prostatectomy (LRP) represents an established treatment modality for localised prostate cancer. Objective To report standardised complication rates for LRP, evaluate the development of complication rates over time, and show changes within the learning curves of laparoscopic surgeons. Design, setting, and participants We conducted a standardised analysis of 2200 consecutive patients who underwent LRP between 1999 and 2008 at a single institution. Intervention LRP was performed using a transperitoneal ( n = 871) or extraperitoneal ( n = 1329) retrograde Heilbronn technique. Five surgeons operated on 96% of the patients. Measurements Complications were classified according to the modified Clavien system. Total complication rates and changes over time were analysed. Three generations of surgeons were defined for evaluation of learning curves. Results and limitations Minor complications occurred in 21.7% of patients (Clavien 1: 6.8%; Clavien 2: 14.9%); anaemia requiring transfusion (10.4%) dominated. Early reinterventions were necessary in 6.7% of patients (Clavien 3a: 3.6%; Clavien 3b: 1.5%; Clavien 4a: 1.5%; Clavien 4b: 0.1%). Late Clavien 3b complications occurred in 4.7% of patients—most of them anastomotic strictures. Mortality was 0.1% (Clavien 5). There was a significant decrease in overall complication rates over time, resulting predominantly from decreasing Clavien 1–2 events. Learning curves of third-generation surgeons plateaued earlier compared to the first generation (250 vs 700 cases). The limitation of this study is that data concerning comorbidity were not included. Conclusions LRP is a safe procedure characterised by an acceptable profile of complications. Specifically, few major complications are reported. According to the complication rates, the learning curve of third-generation surgeons is significantly shorter compared to first- and second-generation surgeons.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0302-2838 1873-7560
DOI:	10.1016/j.eururo.2010.08.024