title: The impact of fellowship training on pathological outcomes following radical prostatectomy: a population based analysis.
abstract: BACKGROUND
  Radical prostatectomy (RP) is a common treatment for prostate cancer (PCa). Morbidity, mortality and pathological outcomes may be superior in academic institutions. One explanation may be the involvement of oncology fellowship trained urologists within academic institutions. The literature examining pathological outcomes often lacks individual surgeon data. The objective of this study was to compare pathological outcomes following RP between fellowship trained and non-fellowship trained urologists.
  
  
  METHODS
  Population-based, retrospective chart review of men diagnosed with PCa between 2003 and 2008, the majority treated with open approach RP (>99%). Pathological outcomes were compared between oncology fellowship trained academic (FTA), non-fellowship trained academic (NFTA) and non-academic (NA) urologists. Relationships with pathological outcomes were examined utilizing multivariable logistic regression.
  
  
  RESULTS
  83.1% of eligible patients were included in our analysis resulting in 1075 patients. In multivariable analysis, surgeon group was an independent predictor of positive surgical margin (PSM) (p < 0.0001). NFTA and NA urologists were more likely to have PSM compared to FTA urologists (OR 2.50; 95% CI: 1.44-4.35 and OR 2.10; 95% CI: 1.53-2.88, respectively). However, the proportion of PSM between NFTA and NA urologists was not significant (p = 0.492). In addition, pathological stage (p = 0.0004), Gleason sum (p < 0.0001), and surgeon volume (p = 0.017) were associated with PSM. Limitations include retrospective design and lack of clinical and functional outcomes.
  
  
  CONCLUSIONS
  Uro-oncology fellowship trained surgeons had significantly lower rates of PSM than non-fellowship trained surgeons in this population based cohort. This study demonstrates the importance of surgeon-related variables on pathological outcomes and highlights the value of additional urologic oncology fellowship training.
authors.forename: Jasmir G
authors.initials: JG
authors.lastname: Nayak
authors.forename: Darrel E
authors.initials: DE
authors.lastname: Drachenberg
authors.forename: Elke
authors.initials: E
authors.lastname: Mau
authors.forename: Derek
authors.initials: D
authors.lastname: Suderman
authors.forename: Oliver
authors.initials: O
authors.lastname: Bucher
authors.forename: Pascal
authors.initials: P
authors.lastname: Lambert
authors.affiliation: CancerCare Manitoba, Winnipeg, Manitoba, Canada. harvey.quon@cancercare.mb.ca.
authors.forename: Harvey
authors.initials: H
authors.lastname: Quon
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D002983:Clinical Competence; D005257:Fellowships and Scholarships; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D014572:Urology / Q000193:education*