Surgeon case volume and continence recovery following radical prostatectomy: a systematic review.

Autor: Trieu D; Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia., Ju IE; Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia., Chang SB; Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia., Mungovan SF; Westmead Private Physiotherapy Services, Westmead Private Hospital, Sydney, New South Wales, Australia.; The Clinical Research Institute, Sydney, New South Wales, Australia.; Department of Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia., Patel MI; Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.; Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: ANZ journal of surgery [ANZ J Surg] 2021 Apr; Vol. 91 (4), pp. 521-529. Date of Electronic Publication: 2020 Dec 14.
DOI: 10.1111/ans.16491
Abstrakt: Background: Urinary incontinence (UI) is a common complication following radical prostatectomy (RP). Prolonged UI has a substantial impact on quality of life and psychosocial well-being. As the RP technique is complex, it is reasonable to propose that surgeon experience could affect post-operative continence recovery outcomes. This study aimed to systematically evaluate evidence regarding a surgeon's experience and continence recovery after RP.
Methods: A comprehensive search of the literature was performed in April 2020 using the Medline, Embase, CINAHL and psychINFO electronic databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. All English language studies investigating UI following RP, stratified by surgeon experience, were included. Surgeon experience was defined as average annual case load or volume.
Results: Thirteen studies published between 2003 and 2020 met the inclusion criteria and were included in our systematic review. Three prospective and 10 retrospective cohort studies included a total of 47 316 patients undergoing RP via open, laparoscopic or robotic-assisted procedures. Heterogeneity in the definition of surgeon experience and UI did not allow a meta-analysis. The majority of studies reported that surgeons with higher surgical volumes achieved better continence recovery rates at the early (6-week), 3-month, 6-month and later (≥12-month) time points. Most studies where a high surgical volume was defined as >50 cases/year demonstrated a significant difference in continence outcomes.
Conclusion: Better urinary continence recovery results can be expected by patients who undergo RP performed by a surgeon with greater experience. An annual surgical case load of >50 cases/year results in improved continence recovery outcomes following RP.
(© 2020 Royal Australasian College of Surgeons.)
Databáze: MEDLINE
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