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• W4226456876 abstract "You have accessJournal of UrologyCME1 May 2022MP41-14 THE LEARNING CURVE OF RADICAL NEPHRECTOMY FOR KIDNEY CANCER: IMPLICATIONS FOR SURGICAL TRAINING Federico Belladelli, Giuseppe Fallara, Giuseppe Rosiello, Daniele Cignoli, Giuseppe Basile, Gianmarco Colandrea, Giacomo Musso, Francesco Cei, Daniela Canibus, Walter Cazzaniga, Gianfranco Baiamonte, Chiara Re, Andrea Ieva, Pierre I. Karakiewicz, Federico Dehò, Patrizio Rigatti, Giorgio Guazzoni, Andrea Gallina, Alexandre Mottrie, Francesco Montorsi, Roberto Bertini, Andrea Salonia, Alberto Briganti, Umberto Capitanio, and Alessandro Larcher Federico BelladelliFederico Belladelli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Giacomo MussoGiacomo Musso More articles by this author , Francesco CeiFrancesco Cei More articles by this author , Daniela CanibusDaniela Canibus More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Gianfranco BaiamonteGianfranco Baiamonte More articles by this author , Chiara ReChiara Re More articles by this author , Andrea IevaAndrea Ieva More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Federico DehòFederico Dehò More articles by this author , Patrizio RigattiPatrizio Rigatti More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , and Alessandro LarcherAlessandro Larcher More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002607.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Experience (EXP) is a human factor that importantly affect surgery: the relationship between increasing surgical experience and better clinical outcomes defines the learning curve of a procedure. In this regard, no data are available with respect to radical nephrectomy (RN) for kidney cancer. The aim of the study was to investigate the effect of EXP on patient’s outcomes after RN. METHODS: Patients treated with RN for a cT1-3a cN0 cM0 renal mass at one high-volume Institution by 15 surgeons were assessed into a prospective database. For each patient, EXP was defined as the total number of RN performed by each surgeon before the patient's operation. Primary outcomes of the study were all-cause mortality (ACM), clinical progression (CP) Clavien-Dindo ≥2 postoperative complications (CD ≥2) and estimated glomerular filtration rate [eGFR] at 12 months. Secondary outcome of the study was operative time (OT). Multivariable Cox (ACM, CP), logistic (CD ≥2) and linear regression (eGFR, OT) models tested the effect of EXP on the outcomes. Restricted cubic splines were used to test for the non-linear nature of the relationship between EXP and the outcomes. Covariates consisted of age, Charlson comorbidity index, preoperative eGFR, pathological tumour size, tumour grade, T-stage, N-stage, surgical approach and year of surgery to precisely account for case mix. RESULTS: Overall, 1,184 patients were evaluated. Median EXP was 60 cases (interquartile range [IQR] 26-146). After a medianfollow-up of 81 months, the 5-year rates of ACM and CP were 13 and 12%. The rate of CD ≥2 was 14%. The median 1-year eGFR was 56 mL/min/1.73 m2 (IQR 47-68). At multivariable analyses, EXP was not associated with ACM (p=0.7), CP (p=0.2), CD ≥2 complications (p=0.6) and 12-months eGFR (p=0.9). Conversely, EXP was associated with lower estimated operative time (Estimate-0.9; 95% Confidence intervals-1.7 to -2.5; p <0.01; Figure 1). CONCLUSIONS: EXP does not impact the risk of mortality, cancer control, morbidity or renal function impairment in candidates for RN, although experienced surgeons performed faster surgeries. The very large cohort examined, and the extensive follow-up support the validity of this negative findings. Kidney cancer patients elected for RN and treated by novices have the same clinical outcomes of those treated by experienced surgeons; hence RN represent an ideal scenario for surgical training, provided the planning of longer OT. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e725 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Federico Belladelli More articles by this author Giuseppe Fallara More articles by this author Giuseppe Rosiello More articles by this author Daniele Cignoli More articles by this author Giuseppe Basile More articles by this author Gianmarco Colandrea More articles by this author Giacomo Musso More articles by this author Francesco Cei More articles by this author Daniela Canibus More articles by this author Walter Cazzaniga More articles by this author Gianfranco Baiamonte More articles by this author Chiara Re More articles by this author Andrea Ieva More articles by this author Pierre I. Karakiewicz More articles by this author Federico Dehò More articles by this author Patrizio Rigatti More articles by this author Giorgio Guazzoni More articles by this author Andrea Gallina More articles by this author Alexandre Mottrie More articles by this author Francesco Montorsi More articles by this author Roberto Bertini More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Umberto Capitanio More articles by this author Alessandro Larcher More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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• W4226456876 title "MP41-14 THE LEARNING CURVE OF RADICAL NEPHRECTOMY FOR KIDNEY CANCER: IMPLICATIONS FOR SURGICAL TRAINING" @default.
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