The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy：experience of a single surgeon with 500cases in Taiwan, China

摘要

To analyze the learning curve for cancer control from an initial 250cases(GroupI) and subsequent 250cases(GroupII) of robotic‑assisted laparoscopic radical prostatectomy(RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin(PSM) and biochemical recurrence(BCR) were assessed as cancer control outcomes. Patients in GroupII had signiifcantly more advanced prostate cancer than those in GroupI(22.2%vs 14.2%, respectively, with Gleason score 8–10,P=0.033; 12.8%vs 5.6%, respectively, with clinical stage T3,P=0.017). The incidence of PSM in pT3 was decreased signiifcantly from 49% in GroupI to 32.6% in GroupII. Ameaningful trend was noted for a decreasing PSM rate with each consecutive group of 50cases, including pT3 and high‑risk patients. Neurovascular bundle(NVB) preservation was signiifcantly inlfuenced by the PSM in high‑risk patients(84.1% in the preservation groupvs 43.9% in the nonpreservation group). The 3‑year, 5‑year, and 7‑year BCR‑free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased signiifcantly after 250cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50cases. NVB preservation during RALP for the high‑risk group is not suggested due to increasing PSM.