Does the surgeon's learning curve impact pentafecta outcomes in radical prostatectomy? A systematic review and meta-analysis.

Abstract

e17143 Background: Radical prostatectomy is a key treatment for prostate cancer. However, the impact of the learning curve of the surgeon has on the pentafecta is unclear. This meta-analysis aims to determine the impact of a procedure being performed in the initial learning curve has on the surgical results. Methods: A systematic review of MEDLINE, Embase, Scopus, Web of Science, and Google Scholar was conducted up to March 2024, focusing on comparing the results of radical prostatectomies performed among the first 100 cases of the learning curve (initial learning curve) versus procedures performed after 100 cases experience (advanced learning curve) . Primary outcomes were BCR, positive surgical margin (PSM) rate, continence, potency, and complications (Clavien-Dindo classification). Secondary outcomes included operative time and blood loss. Bias was assessed using the ROBINS-I tool, and statistical analysis was done via Review Manager 5.4. Results: Sixteen studies with 21,851 patients were included. No significant difference in BCR rates was found between procedures performed initial and advanced learning curves (OR 1.44; 95%CI 0.97,2.13; p=0.07;I²=74%) and no significant difference in continence rates (OR -0.05 ; 95%CI -0.10, 0.01 ; p=0.08;I²=86%) was observed. However, patients operated by surgeons in their first 100 cases of their learning curves' showed higher PSM rates (OR 1.61;95%CI 1.19,2.17; p=0.002;I²=88%), less potency (OR 0.51; 95%CI 0.29,0.87; p=0.01;I²=87%), more blood loss (OR 69.32; 95%CI 33.63,105.0; p=0.0001;I²=48%), longer operative times (OR 55.46; 95%CI 38,72.92; p<0.0001;I²=89%), and more complications (OR 2.04; 95%CI 1.05,3.96; p=0.03;I²=70%). Conclusions: This meta-analysis highlights that procedures performed in the initial learning curve have inferior results in three out of the five parameters of pentafecta. These must be taken in account when choosing who should be trained for this procedure.