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Should surgeon specific factors be incorporated in prediction modeling? ,[object Object],[object Object],[object Object]
Does a patient ’s chance of cure depend on the surgeon? ,[object Object],[object Object],[object Object],[object Object]
Complications after radical prostatectomy Volume -------------- Outcome Low Medium High Very High Postoperative complications 32% 31% 30% 26% Urinary complications 28% 26% 27% 20%
 
The learning curve for open radical prostatectomy
Organ confined Non-organ confined
 
Patient characteristics laparoscopic learning curve Prior cases (surgeon experience) before incident case < 50 50-99 100-249 250-1000 p n 793 611 946 2352 PSA (ng / ml) 6.9 (5.0, 10.0) 6.8 (5.0, 9.8) 7 (5.1, 10.3) 5.9 (4.3, 8.5) 0.11 Age at RP 64 (59, 68) 64 (59, 68) 63 (58, 68) 61 (56, 66) 0.036 Path. Gleason 0.4 ≤  6 365 (46%) 255 (42%) 439 (46%) 1024 (44%) 7 375 (47%) 311 (51%) 423 (45%) 1180 (50%) ≥  8 53 (7%) 45 (7%) 84 (9%) 148 (6%) Non-organ confined 247 (31%) 205 (34%) 304 (32%) 612 (26%) 0.3
Principal analysis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Open RP Laparoscopic RP
What about variation of functional outcomes? ,[object Object],[object Object],[object Object],[object Object]
 
 
Surgeon experience affects predictiveness Locally advanced disease Gleason 8 Gleason 7 PSA AUC 0.750 for patients treated by surgeons with <50 cases 0.849 for patients treated by surgeons with >500 cases
Surgeon specific factors and prediction modelling ,[object Object],[object Object]
Application of models created in academic centers ,[object Object],[object Object],[object Object],[object Object],[object Object]
CAPRA vs. Stephenson
 
Prediction models and surgeon specific factors ,[object Object],[object Object]
Nomogram including surgeon experience
Nomogram including surgeon experience: AUC 0.812 vs. 0.811
Radical prostatectomy outcomes collaboration
Inclusion of surgeon factors in prediction models ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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