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Learning curve's impact on positive surgical margins in RALRP: A prospective cohort study and meta-analysis
Abdalla Ali Deb1, Naufal Naushad2, Stavros Moschonas2
1Department of Urology, James Cook University Hospital, Middlesbrough, United Kingdom.
Introduction:
Robot-assisted laparoscopic radical prostatectomy (RALRP) is becoming increasingly adopted for prostate cancer; however, it is associated with a steep but achievable learning curve. The effect of that curve - particularly on positive surgical margin (PSM) rates, a key oncological outcome - remains underexplored.
Objective:
To assess the effect of surgical experience on RALRP outcomes through a prospective cohort study and to contextualize findings via a systematic review and meta-analysis of PSM incidence across learning curve stages.
Material:
We conducted a prospective study of 100 consecutive patients who underwent RALRP at a single center, grouped as cases 1-50 (Group I) and 51-100 (Group II) comparing perioperative, pathological, and functional outcomes. Additionally, a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines was conducted using random effects modelling.
Results:
Significant improvements in operative time, blood loss, hospital stay, and early functional recovery were noted in Group II. The PSM rate declined from 30 to 14% (P=0.053), approaching thus statistical significance, with no significant difference in biochemical recurrence. The meta-analysis included 22 studies and demonstrated a pooled PSM rate of 28% (95% CI: 24-33%) for surgeons with≤100 cases, decreasing to 22% (95% CI: 17-27%) for 101-200 cases, and to 18% (95% CI: 14-22%) for 401-500 cases. Similar trends were observed in both pT2 and pT3 subgroups. Due to heterogeneity in reporting, other perioperative outcomes could not be meta-analyzed.
Conclusion:
Surgical experience significantly influences PSM rates in RALRP. These findings highlight the need for structured robotic training and standardized reporting to optimize oncologic outcomes in prostate cancer surgery.
Level Of Evidence:
Level III, Retrospective Cohort.
