Hospital Volume & Surgical Experience Key to Prostate Cancer Outcomes

Memorial Sloan-Kettering Cancer Center
Wednesday, 10 April 2002

Men diagnosed with prostate cancer often have concerns about the complications that affect their quality of life after surgery, the most common treatment for early-stage prostate cancer in which the disease has not spread beyond the region of the prostate. A new study conducted by researchers at Memorial Sloan-Kettering Cancer Center suggests that these patients should consider two key things prior to undergoing the procedure: the number of operations performed at the hospital and the number of operations completed by the surgeon.

According to the research, published in the April 11 issue of The New England Journal of Medicine,* prostate cancer patients are likely to have fewer urinary complications after prostatectomy (surgery to remove the prostate and some surrounding tissue) when it is done either at a high-volume hospital or by a surgeon who performs the procedure frequently. The findings offer insight that could help patients as they think about where to have this type of operation.

"This information is significant for the nearly 100,000 men who undergo prostatectomies each year," said coauthor Peter Scardino, MD, Chairman, Department of Urology at Memorial Sloan-Kettering. "While it may seem like common sense, having data that shows a measurable reduction in side effects like urinary incontinence is very important to both surgeons and patients."

Prostatectomy is associated with a very low overall risk of death, but has the potential for postoperative and long-term complications that affect quality of life and may be influenced by variations in surgical technique and follow-up care.

In the current study, researchers used Medicare claims records from the Surveillance, Epidemiology, and End Results (SEER) database, to retrospectively evaluate the health-related outcomes of 11,522 prostate cancer patients aged 65 years and older who had a prostatectomy between 1992 and 1996.

According to the analysis, higher hospital and surgeon volume correlated with decreased rates of postoperative complications in the first 30 days after surgery and with later urinary problems such as urinary strictures and bladder obstruction within one year following the procedure, even after taking into account the patients' age, race, stage of disease at diagnosis, and other variables.

For every 100 men receiving prostatectomy at a high-volume hospital, five would be spared a post-operative complication and eight would be spared urinary side effects when compared with the results at low-volume hospitals, according to the researchers. In addition, patients who choose an experienced surgeon instead of one who performs these procedures infrequently would obtain a similar improvement in the chances of a successful operation.

"Learning more about the factors that affect patient outcomes will allow health care providers to improve patient care in the future," said lead author Colin Begg, PhD, Chairman, Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering.

In a subsequent analysis of the highest-volume surgeons, researchers found substantial differences in outcome among their patients. According to Dr. Begg, this suggests that individual surgical skill and technique further impacts the results of prostatectomy. Adds Dr. Scardino, "We are always looking for ways to enhance the standard of care, and this data will be useful as we strive for optimal results through continuing education and training in the most state-of-the-art surgical techniques."

Memorial Sloan-Kettering Cancer Center is the world's oldest and largest institution devoted to prevention, patient care, research and education in cancer. Our scientists and clinicians generate innovative approaches to better understand, diagnose and treat cancer. Our specialists are leaders in biomedical research and in translating the latest research to advance the standard of cancer care worldwide.

For more information, or to contact Memorial Sloan-Kettering Cancer Center, see their website at: www.mskcc.org