Influences of Surgical Volume on Perioperative and Oncological Outcomes Following Radical Prostatectomy.

INTRODUCTION: The purpose of this study was to evaluate whether the number of radical prostatectomies per hospital per year is associated with stage distribution, surgical techniques or quality related outcome in Germany. MATERIALS AND METHODS: A German Internet-based database was analyzed. Hospitals were categorized according to their yearly radical prostatectomy (RP) volume. Patient's characteristics, RP techniques, and outcome-related parameters were compared between the different hospital volume categories. RESULTS: A total of 6,447 patients were analyzed. The highest rate of organ-confined disease and the lowest rate of extracapsular invasion have been demonstrated in very low-volume centres (72.6%

[The Onkonet database: taking stock of an Internet-based, multi-centre database on surgical prostate cancer treatment]. / Die Onkonet-Datenbank: Bilanz einer Internet-basierten, multizentrischen Dokumentationsplattform zur Erfassung der operativen Therapie des Prostatakarzinoms.

BACKGROUND: The Onkonet database has been developed and coordinated by the Berliner Tumorzentrum e. V. (http://www.prostata-ca.net) and contains data on pre-, peri- and postoperative parameters of radical prostatectomy documented since January 2005. With its user-friendly interface and its integrated benchmarking tool, the main goal of Onkonet was to outline and improve the surgical care of prostate cancer patients in Germany. This study aimed to analyse all Onkonet data documented from the beginning of the project until June 2018. We focused on the completeness and plausibility of data to investigate and define the possibilities and limits of further analyses. PATIENTS AND METHODS: All patients who underwent radical prostatectomy in one of the urological clinics participating in this project until June 2018 were included in this retrospective study. The completeness of all documented patient data was analysed using Excel 2013. The statistical analysis was descriptive. RESULTS: A total of 21 474 patients were documented in Onkonet. 58,6 % (12 591) of them had a complete dataset including date of birth, date of surgery, dates of hospitalisation and discharge, initial PSA value, Gleason score of the biopsy, clinical T stage, pathological T stage, pathological Gleason score, as well as information on the surgical technique. Mean completeness of pre-operative parameters was 26,8 %, of hospitalisation parameters 64,5 %, and of pathological parameters 58,1 %. Amongst these, the documentation of the pathological T stage was complete in 80,1 %, documentation of N stage in 78,8 %, of M stage in 74,8 %, of pathological Gleason Score in 78,7 %, and of R1 status in 78,7 %. Completeness of follow-up data was 8,1 %, with PSA data being available in 27,2 %, continence data in 23,0 %, and potency data in 13,9 %. CONCLUSIONS: Comprising 21 474 documented patients and over 200 parameters, Onkonet is one of the most comprehensive clinical registers for the documentation of prostate cancer patients in Germany. The data analysis showed that the limitations of such a database are mainly due to the high number of parameters and the high susceptibility to errors due to manual data submission.

[The use of partial nephrectomy in the treatment of patients with pT1/pT2 renal cell carcinoma: a trend analysis from a tertiary referral centre]. / Anwendung der organerhaltenden Nierentumorchirurgie in der Behandlung von Patienten mit Nierenzellkarzinom im Stadium pT1/pT2 ­ eine unizentrische Trendanalyse.

INTRODUCTION: In patients with localised renal cell carcinoma, the only curative treatment option is surgical tumour excision. Current national and European guidelines recommend partial nephrectomy in the form of an open or minimally-invasive procedure in case of small tumours. The aim of this study was to examine the use of radical (RN) or partial (PN) nephrectomy performed as open or minimally-invasive procedures in patients with pT1 /pT2 renal cell carcinoma at a tertiary referral centre. PATIENTS AND METHODS: This retrospective study included a total of 758 patients with localised renal cell carcinoma (pT1/pT2), who underwent PN or RN between 01/2008 and 10/2014. Nephrectomy was either performed as an open (OPN, ORN), laparoscopic (LPN, LRN) or robot-assisted laparoscopic (RAPN) procedure. RESULTS: Out of 758 patients, 439 (57.9 %) underwent PN performed as an LPN in n = 254 (57.9 %) and OPN in n = 185 (42.1 %). 319 patients (42.1 %) underwent RN performed as an LRN in n = 250 (78.4 %) and ORN in n = 69 (21.6 %). Between 2008 and 2014, there was a trend towards the use of PN, especially in patients with pT1a and pT1b. The majority of patients with pT2 underwent RN, performed as an LRN in 40 - 53.9 %. DISCUSSION: The results of this trend analysis from a tertiary referral centre demonstrate an increased use of PN and minimally-invasive procedures over time, as recommend by national and European guidelines.

The Effect of Evolving Strategies in the Surgical Management of Organ-Confined Prostate Cancer: Comparison of Data from 2005 to 2014 in a Multicenter Setting.

INTRODUCTION: The objective of this study was to evaluate changes of patient characteristics and surgical techniques in radical prostatectomy in Germany within the last decade. METHODS: Data from 44 German prostate cancer centers were included in the study. Patients' characteristics (age, initial PSA value), surgical techniques (open vs. minimally invasive approaches), perioperative parameters (operating time, rate of nerve-sparing (NS) radical prostatectomies (RPs), hospitalization time, catheter indwelling time, surgical margin status, number of dissected lymph nodes (LN)), and pathological findings (tumor stage, Gleason score) were analyzed. RESULTS: Data from 11,675 patients who underwent RP between 2005 and 2014 were analyzed. The rate of open RP approaches decreased by 1.7% (p = 0.0164), the rate of minimally invasive approaches increased by 1.8% (p = 0.0164). Robot-assisted RPs (RARP) increased by 4.6% (p < 0.0001). The number of NS procedures and pelvic lymphadenectomy (LA) increased by 4.5% (p < 0.0001) and 4.7% (p < 0.0001), respectively. Catheter indwelling time and hospitalization time decreased by 1 day (p < 0.0001). No change in the rate of positive surgical margins (p = 0.5061) and the ratio of positive lymph nodes removed (p = 0.4628) was observed. The number of Gleason ≤6 tumors decreased significantly (p < 0.0001). CONCLUSIONS: The number of RARP has significantly increased over the past decade and there is a trend towards surgeries on more advanced tumors with higher yields of lymph nodes dissected. At the same time, the rate of nerve-sparing procedures has significantly increased.