CONTEXT: The impact of surgeon and hospital volume on outcomes after radical prostatectomy (RP) for localised prostate cancer (PCa) remains unknown. OBJECTIVE: To perform a systematic review on the association between surgeon or hospital volume and oncological and nononcological outcomes following RP for PCa. EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. All comparative studies for nonmetastatic PCa patients treated with RP published between January 1990 and May 2020 were included. For inclusion, studies had to compare hospital or surgeon volume, defined as caseload per unit time. Main outcomes included oncological (including prostate-specific antigen persistence, positive surgical margin [PSM], biochemical recurrence, local and distant recurrence, and cancer-specific and overall survival) and nononcological (perioperative complications including need for blood transfusion, conversion to open procedure and within 90-d death, and continence and erectile function) outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Both a narrative and a quantitative synthesis were planned if the data allowed. EVIDENCE SYNTHESIS: Sixty retrospective comparative studies were included. Generally, increasing surgeon and hospital volumes were associated with lower rates of mortality, PSM, adjuvant or salvage therapies, and perioperative complications. Combining group size cut-offs as used in the included studies, the median threshold for hospital volume at which outcomes start to diverge is 86 (interquartile range [IQR] 35-100) cases per year. In addition, above this threshold, the higher the caseload, the better the outcomes, especially for PSM. RoB and confounding were high for most domains. CONCLUSIONS: Higher surgeon and hospital volumes for RP are associated with lower rates of PSMs, adjuvant or salvage therapies, and perioperative complications. This association becomes apparent from a caseload of >86 (IQR 35-100) per year and may further improve hereafter. Both high- and low-volume centres should measure their outcomes, make them publicly available, and improve their quality of care if needed. PATIENT SUMMARY: We reviewed the literature to determine whether the number of prostate cancer operations (radical prostatectomy) performed in a hospital affects the outcomes of surgery. We found that, overall, hospitals with a higher number of operations per year have better outcomes in terms of cancer recurrence and complications during or after hospitalisation. However, it must be noted that surgeons working in hospitals with lower annual operations can still achieve similar or even better outcomes. Therefore, making hospital's outcome data publicly available should be promoted internationally, so that patients can make an informed decision where they want to be treated.

Department of Medicine Health Science Centre McMaster University Hamilton Ontario Canada

Department of Oncological Urology University Medical Centre Utrecht Cancer Centre Utrecht The Netherlands

Department of Radiation Oncology University Hospital Ulm Ulm Germany

Department of Radiology and Nuclear Medicine Amsterdam University Medical Centres VU University Amsterdam The Netherlands

Department of Radiology and Nuclear Medicine Erasmus MC University Medical Centre Rotterdam The Netherlands; Department of Radiology Netherlands Cancer Institute Amsterdam The Netherlands

Department of Surgery Central Clinical School Monash University Australia

Department of Urology Aberdeen Royal Infirmary Aberdeen UK

Department of Urology Antonius Hospital Utrecht The Netherlands

Department of Urology Charité University Hospital Berlin Germany; Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Hatzikosta General Hospital Ioannina Greece

Department of Urology Liverpool University Hospitals Liverpool UK

Department of Urology Metropolitan General Hospital Athens Greece

Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands

Department of Urology University Hospital St Etienne France

Department of Urology University Hospitals Leuven Leuven Belgium

Department of Urology Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust Wigan UK

Division of Cancer and Genetics School of Medicine Cardiff University Velindre Cancer Centre Cardiff UK

Hasselt Belgium

Hospices Civils de Lyon Department of Urinary and Vascular Imaging Hôspital Edouard Herriot Lyon France

La Croix du Sud Hospital Quint Fonsegrives France

Leicester City Hospital Leicester UK

Martini Klinik Prostate Cancer Centre Hamburg Germany; Department of Urology University Hospital Hamburg Eppendorf Hamburg Germany

Medicine for Older People Saint Vincent's University Hospital Dublin Ireland

Oncology Institute of Southern Switzerland Bellinzona Switzerland; Università della Svizzera Italiana Lugano Switzerland

Pecanka Consulting Services Prague Czech Republic

Unit of Urology Division of Oncology Urological Research Institute IRCCS Ospedale San Raffaele Milan Italy

Eur Urol. 2021 Nov;80(5):546-548. doi: 10.1016/j.eururo.2021.05.021. PubMed

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