title: Impact of fellowship training on pathologic outcomes and complication rates of radical prostatectomy.
abstract: BACKGROUND
  The study was conducted to assess the results of radical prostatectomy (RP) performed by fellowship-trained surgeons in the first year of independent practice.
  
  
  METHODS
  A prospective cohort study of 66 men who underwent RP performed by 2 recently graduated fellowship-trained surgeons (C.J.R., n = 27; A.M.K., n = 39) in their first year of independent practice was undertaken. Preoperative, operative, and postoperative data were collected and analyzed. Median follow-up of the cohort is 12.5 months.
  
  
  RESULTS
  The median patient age was 61.2 +/- 6.9 years (range, 44-74 years), the median prostate-specific antigen level was 5 ng/mL (range, 1.2-39.4 ng/mL), and the median prostate biopsy-determined Gleason score was 7. Of the 66 men, 25 (38%) underwent a bilateral nerve-sparing RP, 20 (30%) underwent a unilateral nerve-sparing RP, and 21 (32%) underwent a nonnerve-sparing procedure. Forty-two men (63%) underwent a pelvic lymph node dissection. The median operative time was 201 minutes. Median estimated blood loss was 734 mL (range, 300-1600 mL). There were 4 major complications--a pulmonary embolism in 3 patients and an intraoperative rectal injury in 1. Pathologic classification was as follows: pT2, 74%; pT3a, 23%; pT3b, 2%; and pN+, 2%. The positive margin rate was 14% overall and only 2% in men with pT2 disease.
  
  
  CONCLUSIONS
  Results of RP performed by fellowship-trained surgeons in their first year of practice compare favorably with results of RP in a large series reported by more experienced surgeons. Being trained in an environment where an experienced surgeon serves as first assistant to the trainee appears to abbreviate the learning curve associated with this procedure.
authors.affiliation: Division of Urology, University of Florida, Jacksonville, Florida 32209, USA. charles.rosser@jax.ufl.edu
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Rosser
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
authors.forename: John
authors.initials: J
authors.lastname: Pendleton
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Robinson
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
authors.forename: David A
authors.initials: DA
authors.lastname: Swanson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Babaian
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D005257:Fellowships and Scholarships; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011468:Prostatectomy / Q000193:education / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013781:Texas; D014572:Urology / Q000193:education*