Laparoscopic Radical Prostatectomy: Learning Curves for Surgical, Oncological, and Functional Outcome

ABSTRACT

PURPOSE: We report our experience with laparoscopic radical prostatectomy (LRP) and investigate the learning curves for various outcome variables for LRP. MATERIALS AND METHODS: From January 2005 to March 2008, 47 patients with prostate cancer with a clinical stage < or =T3a underwent LRP by a single surgeon. We retrospectively reviewed the medical records of the patients regarding to the surgical, oncological, and functional outcomes. RESULTS: The median follow-up for the entire group was 38 months (18-49). In surgical outcomes, the operative time was decreased to less than 300 minutes after 5 cases and the estimated blood loss was stabilized after 30 cases. The positive surgical margin rate was decreased within the first 30 cases, but not significantly so. For functional outcomes, the urinary continence rates at 1 month, 3 months, 6 months, and 1 year postoperatively were 17.0%, 53.2%, 72.3%, and 80.9%, respectively. Neurovascular bundle saving was performed in 11 cases (23.4%). In cases of neurovascular bundle saving, the potency rates at 3 months, 6 months, and 1 year postoperatively were 27.3%, 27.3%, and 54.5%, respectively. Analysis of the learning curve for functional outcome revealed no statistical differences in the continence rate or potency rate with time. CONCLUSIONS: In the present study, the learning curve for operative time was overcome within the first 5 cases, and estimated blood loss took 30 cases to reach a plateau. The longest learning curve was for functional outcomes such as continence and potency, which did not stabilize until 47 cases.