A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer

Thomas van den Broeck, Daniela Oprea-Lager, Lisa Moris, Mithun Kailavasan, Erik Briers, Philip Cornford, Maria de Santis, Giorgio Gandaglia, Silke Gillessen Sommer, Jeremy P. Grummet, Nikos Grivas, Thomas B. L. Lam, Michael Lardas, Matthew Liew, Malcolm Mason, Shane O'Hanlon, Jakub Pecanka, Guillaume Ploussard, Olivier Rouviere, Ivo G. SchootsDerya Tilki, Roderick C. N. van den Bergh, Henk van der Poel, Thomas Wiegel, Peter-Paul Willemse, Cathy Y. Yuan, Nicolas Mottet

Research output: Contribution to journalReview articleAcademicpeer-review

21 Citations (Scopus)


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.
Original languageEnglish
Pages (from-to)531-545
Number of pages15
JournalEuropean Urology
Issue number5
Early online date2021
Publication statusPublished - Nov 2021


  • Evidence synthesis
  • Functional outcomes
  • Hospital volume
  • Oncological outcomes
  • Surgeon volume
  • Systematic review

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