Evaluation of short term surgical outcomes of radical prostatectomy in the decade following the introduction of minimum volume standards in the Netherlands

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-04-21 DOI:10.1016/j.urolonc.2025.03.020

Caroline M. van der Starre , Katja K.H. Aben , Pim J. van Leeuwen , Martijn B. Busstra , Matthijs J.V. Scheltema , Max H. Bruins , Herman Roelink , Henk G. van der Poel , Igle J. de Jong , Berdine L. Heesterman , Diederik M. Somford

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引用次数: 0

Abstract

Introduction

A minimum volume standard (MVS) of 20 radical prostatectomies (RPs) per institution per year was implemented in the Netherlands in 2014, and raised to 50 RPs in 2018 and 100 in 2019. This study aimed to evaluate the effects of implementing a MVS on the extent of care centralization and short term surgical outcomes.

Methods

All patients who underwent RP between 2014 and 2022 were identified in the nationwide Netherlands Cancer Registry. Short term surgical outcomes included positive surgical margins (PSMs), PSA persistence (failure to achieve a PSA value <0.1 ng/mL within 6 months after RP) and complications (Clavien-Dindo grade ≥3) up to 30 days after RP. Multivariable logistic regression analyses were performed to evaluate surgical outcomes over time.

Results

Between 2014 and 2022, 24,576 RPs were performed and the number of hospitals performing RPs decreased substantially from 40 in 2014 to 14 in 2022, whereas the median number of RPs per hospital per year increased from 85 (IQR: 57–139) to 189 (IQR: 157–393). PSM-rate decreased from 51.6% to 45.7% for pT3-4 (OR = 0.95, 95% CI 0.93–0.98) and 23.6% to 17.6% for pT2 (OR = 0.93, 95% CI 0.91–0.96) prostate cancer. A decline was observed in PSA persistence from 14.0% to 7.7% (OR = 0.84, 95% CI 0.82–0.87). Also the grade ≥3 complication-rate slightly decreased from 3.9% to 3.0% (OR = 0.94, 95% CI 0.90–0.98).

Conclusion

Introduction of a MVS resulted in a substantial centralization of RP-care in the Netherlands. A gradual, but moderate, improvement was observed in complications, PSMs and PSA persistence after RP.

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荷兰引入最小体积标准后十年根治性前列腺切除术的短期手术效果评估。

2014年，荷兰实施了每个机构每年20例根治性前列腺切除术（RPs）的最低容量标准（MVS）， 2018年提高到50例，2019年提高到100例。本研究旨在评估实施MVS对护理集中程度和短期手术结果的影响。方法：在2014年至2022年期间，所有接受RP的患者都在荷兰全国癌症登记处进行了鉴定。结果：2014年至2022年间，共实施了24,576例RPs，实施RPs的医院数量从2014年的40家大幅减少到2022年的14家，而每家医院每年RPs的中位数从85家（IQR: 57-139）增加到189家（IQR: 157-393）。pT3-4前列腺癌的psm率从51.6%降至45.7% (OR = 0.95,95% CI 0.93-0.98)， pT2前列腺癌的psm率从23.6%降至17.6% （OR = 0.93,95% CI 0.91-0.96）。PSA持久性从14.0%下降到7.7% （OR = 0.84,95% CI 0.82-0.87）。≥3级并发症发生率从3.9%下降到3.0% （OR = 0.94,95% CI 0.90-0.98）。结论：MVS的引入导致了荷兰rp护理的实质性集中。RP术后并发症、pms和PSA持续性均有逐渐但适度的改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.