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The following is a summary of “Does the surgeon’s learning curve impact pentafecta outcomes in radical prostatectomy? a systematic review and meta-analysis,” published in the May 2025 issue of BMC Urology by Cruz et al. 

Researchers conducted a retrospective study to analyze how performing radical prostatectomy during the initial learning curve affected pentafecta surgical outcomes.  

They performed a systematic review across MEDLINE, Embase, Scopus, Web of Science, and Google Scholar, covering studies published up to March 2024 that focused on learning curves in prostatectomy. The primary outcome assessed was the biochemical recurrence rate (BCR) while, the Secondary outcomes included positive surgical margin (PSM) rate, urinary continence, sexual potency, operative time, blood loss, and complication rates (Clavien-Dindo classification). Risk of bias was estimated by ROBINS-I tool. Statistical analysis was carried out using Review Manager version 5.4.  

The results showed that 16 studies involving 21,851 individuals were analyzed. No significant difference in BCR was found between early and advanced learning curves (Odds Ratio (OR) 1.44; 95% CI 0.97, 2.13; P= 0.07; I² =74%). Continence outcomes also showed no significant variation (RD -0.05; 95% CI -0.10, 0.01; P= 0.08; I² =86%).  The PSM rates were lower in advanced learning phases (OR 1.61; 95% CI 1.19, 2.17; P= 0.002; I² =88%). Higher sexual potency, reduced blood loss, shorter operative duration, and fewer complications (Clavien-Dindo classification) were associated with advanced stages. Despite the limited feasibility of randomized trials, further well-designed prospective studies were considered necessary to confirm these outcomes.  

Investigators concluded that greater surgical experience, particularly beyond 100 cases, was linked to improved pentafecta outcomes, supporting the need for structured mentorship and case volume targets in training programs. 

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-025-01810-x