title: Does a surgeon's annual radical prostatectomy volume predict the risk of positive surgical margins and urinary incontinence at one-year follow-up? Findings from a prospective national study.
abstract: OBJECTIVE
  This study aimed to assess the prevalence of positive surgical margins (PSM) and urinary incontinence (UI) in relation to surgeons' annual radical prostatectomy (RP) volume.
  
  
  METHODS
  This national study prospectively assessed 521 preoperatively continent patients with prostate cancer (PCa), scheduled for RP by surgeons with high (>50), medium (20-50) or low annual volume (<20) at 14 urological departments in Norway. Patients responded to UI questions from the Expanded Composite prostate cancer index (EPIC-50) before and 1 year after RP. UI was defined as "use of pad(s)" and/or "a moderate or severe urinary leakage problem (ULP)". Preoperative prediction of PSMs and UI was explored in multivariate regression analyses with the following independent variables: surgeons' annual RP volume, type of hospital (university versus community), patient's health, sociodemographic features and PCa characteristics.
  
  
  RESULTS
  Based on histopathological reports, the overall PSM rate was 26%, with differences between the high- (18%), medium- (28%) and low-volume (44%) groups. Increasing PSM rates were predicted by surgeons belonging to the low- and medium-volume categories, prostate-specific antigen> 10 µg/l, Gleason score >7, patient age >65 years and <12 years of education. At 1-year follow-up 40% reported UI, without significant differences between the volume groups. Only 46% of those who used pad(s) experienced ULP. UI was predicted by clinical category ≥T2 and community type of hospital, but not by surgeons' annual RP volume. CONCLUSIONS. Preoperative counselling should take into account the relationship between surgeon's annual RP volume and PSM rate and the current knowledge about UI and ULP.
authors.affiliation: National Resource Center for Late Effects after Cancer Treatment, The Norwegian Radium Hospital, Oslo University Hospital, Norway. andreas.steinsvik@ous-hf.no
authors.forename: Eivind Andreas Svaboe
authors.initials: EA
authors.lastname: Steinsvik
authors.forename: Karol
authors.initials: K
authors.lastname: Axcrona
authors.forename: Anders
authors.initials: A
authors.lastname: Angelsen
authors.forename: Christian
authors.initials: C
authors.lastname: Beisland
authors.forename: Alv
authors.initials: A
authors.lastname: Dahl
authors.forename: Lars Magne
authors.initials: LM
authors.lastname: Eri
authors.forename: Erik Skaaheim
authors.initials: ES
authors.lastname: Haug
authors.forename: Aud
authors.initials: A
authors.lastname: Svindland
authors.forename: Sophie
authors.initials: S
authors.lastname: Fosså
mesh_terms: D000368:Aged; D002983:Clinical Competence; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D009929:Organ Size; D011183:Postoperative Complications; D015995:Prevalence; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy / Q000379:methods* / Q000592:standards; D011471:Prostatic Neoplasms / Q000601:surgery*; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control