From First to Final: How Surgical Experience Affects Robotic Radical Prostatectomy Outcomes

摘要

Objective: To evaluate the impact of surgeon experience on surgical outcomes in robotic-assisted radical prostatectomy (RARP) by comparing the first and last 50 patients in a clinical setting. Materials and Methods: This retrospective study analyzed the first and last 50 patients who underwent RARP for localized prostate cancer at a City Hospital between November 2022 and October 2024. Complications were classified using the Clavien-Dindo classification system. Oncological outcomes were evaluated by assessing surgical margins and postoperative prostate-specific antigen (PSA) levels at 4-8 weeks. Functional outcomes, including continence and potency, were defined as follows: full continence was reported when patients used 0 pads per day without anticholinergic therapy, while potency was defined as the ability to achieve an erection sufficient for sexual intercourse. Results: A total of 100 patients diagnosed with localized prostate cancer were included in this study, divided into two groups: the first 50 patients and the last 50 patients who underwent RARP. The last 50 patients demonstrated significant improvements in perioperative outcomes, including shorter hospital stays (p=0.01), urethral catheter removal times (p=0.03), drainage catheter removal times (p=0.04), and operative times (p=0.02). Complication rates were lower in the last 50 patients, with no grade 5 complications observed in either group. Grade 3 complication rates were 12% in the first 50 patients and 2% in the last 50 patients (p=0.01). Oncological outcomes improved, with positive surgical margins decreasing from 22% to 6% (p=0.02) and undetectable PSA levels increasing from 76% to 90% (p<0.01). In terms of functional outcomes, the continence rate was 88% in the last 50 patients compared to 76% in the first 50 patients (p<0.05). Conclusions: This study demonstrates that surgical experience significantly improves outcomes in RARP for localized prostate cancer. The later cohort exhibited reduced complications, shorter catheter durations, and enhanced oncological and functional results, highlighting the importance of proficiency in achieving optimal patient care.