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  • Nyberg, MartinLund University,Lunds universitet,Urologisk cancerforskning, Malmö,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Urological cancer, Malmö,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Skåne University Hospital (författare)

Surgeon heterogeneity significantly affects functional and oncological outcomes after radical prostatectomy in the Swedish LAPPRO trial

  • Artikel/kapitelEngelska2021

Förlag, utgivningsår, omfång ...

  • 2020-09-29
  • Wiley,2021

Nummerbeteckningar

  • LIBRIS-ID:oai:gup.ub.gu.se/298051
  • https://gup.ub.gu.se/publication/298051URI
  • https://doi.org/10.1111/bju.15238DOI
  • https://lup.lub.lu.se/record/0bc373d2-da69-4a33-a1b5-cfaed0048196URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:144719553URI

Kompletterande språkuppgifter

  • Språk:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Objectives To evaluate how surgeon heterogeneity - the variation in outcomes between individual surgeons - influences functional and oncological outcomes after robot-assisted laparoscopic prostatectomy (RALP) and retropubic radical prostatectomy (RRP), and to assess whether surgeon heterogeneity affects the comparison between RALP and RRP. Patients and Methods Laparoscopic Prostatectomy Robot Open (LAPPRO) is a prospective, controlled, non-randomized trial performed at 14 Swedish centres with 68 operating surgeons. A total of 4003 men with localized prostate cancer were enrolled between 2008 and 2011. The endpoints were urinary incontinence, erectile dysfunction (ED) and recurrence at 24 months after surgery. Logistic regression models were built to evaluate surgeon heterogeneity and, secondarily, surgeon-specific factors were added to the models to investigate their influence on heterogeneity and the comparison between RALP and RRP. Results Among surgeons who performed at least 20 surgeries during the study period (n=25), we observed statistically significant heterogeneity for incontinence (P= 0.001), ED (P< 0.001) and rate of recurrent disease (P< 0.001). The significant heterogeneity remained when analysing only experienced surgeons with a stated experience of at least 250 radical prostatectomies (n=12). Among all participating surgeons (n=68), differences in surgeon volume explained 42% of the observed heterogeneity for incontinence (P= 0.003), 11% for ED (P= 0.03) and 19% for recurrence (P= 0.01). Taking surgeon volume into account when comparing RALP and RRP had a significant impact on the results. The effect was greatest for functional outcomes, and the additional adjustments for the surgeons' previous experience changed whether the difference between techniques was statistically significant or not. The surgeons' annual volume had the greatest effect on the recurrence rate. Conclusions There was a large degree of heterogeneity among surgeons regarding both functional and oncological outcomes and this had a significant impact on the results when comparing RALP and RRP. Some of the observed heterogeneity was explained by differences in surgeon volume. Efforts to decrease heterogeneity are warranted and variation among surgeons must be accounted for when conducting comparative analyses between surgical techniques.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Sjoberg, D. D.Memorial Sloan-Kettering Cancer Center (författare)
  • Carlsson, Sigrid,1982Karolinska Institutet,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för urologi,Institute of Clinical Sciences, Department of Urology,Sahlgrenska Academy(Swepub:lu)si5270ca (författare)
  • Wilderang, U.Sahlgrenska Academy (författare)
  • Carlsson, S.Karolinska Institute (författare)
  • Stranne, Johan,1970Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för urologi,Institute of Clinical Sciences, Department of Urology,Sahlgrenska University Hospital,Sahlgrenska Academy(Swepub:gu)xstraj (författare)
  • Wiklund, PeterKarolinska Institutet,Karolinska Institute(Swepub:lu)extLU-1072 (författare)
  • Steineck, G.Sahlgrenska Academy (författare)
  • Haglind, Eva,1947Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery,Sahlgrenska University Hospital,Sahlgrenska Academy(Swepub:gu)xhagev (författare)
  • Hugosson, Jonas,1955Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för urologi,Institute of Clinical Sciences, Department of Urology,Sahlgrenska University Hospital,Sahlgrenska Academy(Swepub:gu)xhugjo (författare)
  • Bjartell, AndersLund University,Lunds universitet,Urologisk cancerforskning, Malmö,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Urological cancer, Malmö,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Skåne University Hospital(Swepub:lu)kir-abj (författare)
  • Urologisk cancerforskning, MalmöForskargrupper vid Lunds universitet (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:BJU International: Wiley127:3, s. 361-3681464-40961464-410X

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