According to a recent article published in the Journal of Clinical Oncology, patients undergoing radical prostatectomies appear to have fewer complications and shorter hospital stays if their surgeon performs large volumes of prostatectomies each year.
1 These findings are consistent with a previous study evaluating surgical side effects of a prostatectomy and the annual surgical volume of a physician.
Many patients with prostate cancer choose their treatment based not only on which treatment will most effectively fight the disease, but also on which therapy will offer the best quality of life. Because prostate cancer is not always an aggressive cancer, some patients will choose a strategy of delaying any treatment until symptoms appear, called watchful waiting. Other patients may choose external beam radiation therapy or a radical prostatectomy, which is a surgical procedure to remove the prostate gland and some of the surrounding tissue.
One reason that many patients will opt for the strategy of watchful waiting is that both surgery and radiation are associated with unpleasant side effects, including urinary problems and erectile dysfunction. In addition, undergoing the surgical procedure itself poses some risks affecting other body systems.
Researchers from several institutions recently analyzed data from nearly 2,300 men who underwent a radical prostatectomy between 1997 and 1998 at over 1,200 hospitals by nearly 1,800 surgeons. Data regarding surgical complications affecting the heart, lungs, genital or urinary systems, wound healing, vasculature (veins, arteries, capillaries) and miscellaneous medical or surgical conditions were analyzed. In addition, data regarding the volume of prostatectomies performed in a specific hospital and by a specific surgeon were also analyzed and compared to complications related to surgery. Surgeons were classified as “high-volume” surgeons if they had performed 40 or more prostatectomies annually.
The data indicated that patients who underwent a prostatectomy by a high-volume surgeon had only approximately half of the complications caused by the surgery, compared to patients who had a surgeon who performed fewer than 40 prostatectomies annually. The length of time spent in a hospital was also shorter for patients who had high-volume surgeons (4.1 days versus 5.2 days). The volume of prostatectomies performed in a specific institution did not significantly affect surgery-related complications in this group of patients.
These researchers concluded that patients undergoing a prostatectomy appear to have fewer surgery-related complications and shorter hospital stays if their physician performs more than 40 prostatectomies annually. Patients who are considering a radical prostatectomy may wish to be treated by a high-volume surgeon to achieve optimal outcomes.
1.Hu J, Gold K, Pashos C, et al. Role of surgeon volume in radical prostatectomy outcomes.
Journal of Clinical Oncology. 2003;21: 401-405.
2.Begg C, Riedel E, Bach P, et al. Variations in morbidity after radical prostatectomy.
The New England Journal of Medicine. 2002:346;1138-1144.