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The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training
Although radical nephrectomy (RN) is the most common treatment for kidney cancer, no data on the learning curve for RN are available. In this study we investigated the effect of surgical experience (EXP) on RN outcomes using data for 1184 patients treated with RN for a cT1–3a cN0 cM0 renal mass. EXP...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9975008/ https://www.ncbi.nlm.nih.gov/pubmed/36874599 http://dx.doi.org/10.1016/j.euros.2022.12.007 |
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author | Larcher, Alessandro Cei, Francesco Belladelli, Federico Rosiello, Giuseppe Andrea Bravi, Carlo Fallara, Giuseppe Basile, Giuseppe Lucianò, Roberta Karakiewicz, Pierre Mottrie, Alexandre Breda, Alberto Briganti, Alberto Salonia, Andrea Bertini, Roberto Montorsi, Francesco Capitanio, Umberto |
author_facet | Larcher, Alessandro Cei, Francesco Belladelli, Federico Rosiello, Giuseppe Andrea Bravi, Carlo Fallara, Giuseppe Basile, Giuseppe Lucianò, Roberta Karakiewicz, Pierre Mottrie, Alexandre Breda, Alberto Briganti, Alberto Salonia, Andrea Bertini, Roberto Montorsi, Francesco Capitanio, Umberto |
author_sort | Larcher, Alessandro |
collection | PubMed |
description | Although radical nephrectomy (RN) is the most common treatment for kidney cancer, no data on the learning curve for RN are available. In this study we investigated the effect of surgical experience (EXP) on RN outcomes using data for 1184 patients treated with RN for a cT1–3a cN0 cM0 renal mass. EXP was defined as the total number of RNs performed by each surgeon before the patient’s operation. The primary study outcomes were all-cause mortality, clinical progression, Clavien-Dindo grade ≥2 postoperative complications (CD ≥2), and the estimated glomerular filtration rate (eGFR). Secondary outcomes were operative time, estimated blood loss, and length of stay. Multivariable analyses adjusted for case mix revealed no evidence of association between EXP and all-cause mortality (p = 0.7), clinical progression (p = 0.2), CD ≥2 (p = 0.6), or 12-mo eGFR (p = 0.9). Conversely, EXP was associated with shorter operative time (estimate −0.9; p < 0.01). Mortality, cancer control, morbidity, and renal function might not be affected by EXP. The very large cohort examined and the extensive follow-up support the validity of these negative findings. PATIENT SUMMARY: For patients with kidney cancer undergoing surgical removal of a kidney, those treated by novice surgeons have similar clinical outcomes to those treated by experienced surgeons. Thus, this procedure represents a convenient scenario for surgical training if longer operating theatre time can be planned. |
format | Online Article Text |
id | pubmed-9975008 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-99750082023-03-02 The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training Larcher, Alessandro Cei, Francesco Belladelli, Federico Rosiello, Giuseppe Andrea Bravi, Carlo Fallara, Giuseppe Basile, Giuseppe Lucianò, Roberta Karakiewicz, Pierre Mottrie, Alexandre Breda, Alberto Briganti, Alberto Salonia, Andrea Bertini, Roberto Montorsi, Francesco Capitanio, Umberto Eur Urol Open Sci Brief Correspondence Although radical nephrectomy (RN) is the most common treatment for kidney cancer, no data on the learning curve for RN are available. In this study we investigated the effect of surgical experience (EXP) on RN outcomes using data for 1184 patients treated with RN for a cT1–3a cN0 cM0 renal mass. EXP was defined as the total number of RNs performed by each surgeon before the patient’s operation. The primary study outcomes were all-cause mortality, clinical progression, Clavien-Dindo grade ≥2 postoperative complications (CD ≥2), and the estimated glomerular filtration rate (eGFR). Secondary outcomes were operative time, estimated blood loss, and length of stay. Multivariable analyses adjusted for case mix revealed no evidence of association between EXP and all-cause mortality (p = 0.7), clinical progression (p = 0.2), CD ≥2 (p = 0.6), or 12-mo eGFR (p = 0.9). Conversely, EXP was associated with shorter operative time (estimate −0.9; p < 0.01). Mortality, cancer control, morbidity, and renal function might not be affected by EXP. The very large cohort examined and the extensive follow-up support the validity of these negative findings. PATIENT SUMMARY: For patients with kidney cancer undergoing surgical removal of a kidney, those treated by novice surgeons have similar clinical outcomes to those treated by experienced surgeons. Thus, this procedure represents a convenient scenario for surgical training if longer operating theatre time can be planned. Elsevier 2023-01-19 /pmc/articles/PMC9975008/ /pubmed/36874599 http://dx.doi.org/10.1016/j.euros.2022.12.007 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Brief Correspondence Larcher, Alessandro Cei, Francesco Belladelli, Federico Rosiello, Giuseppe Andrea Bravi, Carlo Fallara, Giuseppe Basile, Giuseppe Lucianò, Roberta Karakiewicz, Pierre Mottrie, Alexandre Breda, Alberto Briganti, Alberto Salonia, Andrea Bertini, Roberto Montorsi, Francesco Capitanio, Umberto The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training |
title | The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training |
title_full | The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training |
title_fullStr | The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training |
title_full_unstemmed | The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training |
title_short | The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training |
title_sort | learning curve for radical nephrectomy for kidney cancer: implications for surgical training |
topic | Brief Correspondence |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9975008/ https://www.ncbi.nlm.nih.gov/pubmed/36874599 http://dx.doi.org/10.1016/j.euros.2022.12.007 |
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