European urology supplements vol:37 issue:2 pages:97-97
EAU edition:15 location:Brussels date:12-15 April 2000
INTRODUCTION & OBJECTIVES: The result of oncologic surgery mostly depends on the extent, the stage and grade of the malignancy although surgical quality and skill can have a relevant impact on the oncological outcome and on quality of life. The impact of positive surgical margins on PSA-free survival and the impact of sphincter damage on postoperative incontinence are well documented. The figures of margin positivity and incontinence are quite different amongst different urological centres and this can have a very important economical impact on the treatment of localised prostate cancer since it can imply expensive adjuvant treatment (radiotherapy- hormonotherapy) and incontinence material. Therefore a quality control of radical prostatectomy could be useful. We want to investigate whether quality control is feasible.
MATERIAL & METHODS: 20 Urologists belonging to the EORTC GU Group participated on a voluntary basis. A questionnaire concerning the duration of surgery and transfusion need (surgical score), postoperative PSA and section margins (oncological score), urinary incontinence at catheter withdrawal and at 3 months, stricture occurrence (urological score) was filled out for 10 consecutive patients per urologist.
RESULTS: Major differences amongst urologists were noted as concerned to the duration of surgery and blood loss. These 2 factors were not related to each other. Also, the urinary incontinence at 3 months and PSA persistence was quite variable although only clinical T1 and T2 tumours were included. There was no relation between incontinence and section margins, nor between the surgical score and the urological or oncological outcome. For the different parameters an overall score was calculated by institution demonstrating that some centers obviously did worse than the others.
CONCLUSIONS: There is a difference in quality of radical prostatectomy between different centres. Even a retrospective analysis of patient files can reveal the differences in surgical, oncological and urological score. The difficulty remains to define the gold standard score and its acceptable deviations.