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Nimish Shah publishes outcomes on radical prostatectomy

6th July 2016

CUP partner Nimish Shah has been performing robotic radical prostatectomy (RRP) for the management of prostate cancer since 2006. Cambridge was one of the first centres to introduce RRP in the UK. Nimish has personally performed over 800 of these operations to date.

In 2015, we saw the first national individual Consultant outcomes publication of radical prostatectomy performed in England during 2014, by the British Association of Urological Surgeons. Data was submitted for 5814 patients from England (87% return). 55.6% of cases were performed robotically overall. Median number of cases per consultant was 31 cases (range 1-137 cases). For the first publication, information released to the public included number (including technique) of operations by each surgeon and centre during 2014, with information about blood transfusion rates, post-operative complications and length of stay (http://www.baus.org.uk/patients/surgical_outcomes/default.aspx).

Nimish performed 133 RRPs in 2014, the second highest volume robotic surgeon in England. The blood transfusion rate was 2.27% (England average 2.7%). The median LOS was 1 day (Eng median LOS 2 days).

The audit collected considerable additional operative, pathological and follow-up data which has at this stage not been available to the public domain. An important measure for prostate cancer surgery to assess completeness of resection is the positive surgical margin rate (presence of cancer glands at the resected margin). As seen from the funnel plot below, Nimish Shah’s (red dot) overall positive margin rate was 14.3% against the national average of 28.5%, with the positive margin rate for pT2 (organ confined cancer) of only 6.8%.  55% of cases were pathologically pT3 (extracapsular disease) and 94.7% of cases had Gleason 7 or higher grade disease on final pathology (ie intermediate or high risk disease).

The 2015 patient data will be analysed and comparative individual surgeon data formally published nationally in summer 2016. Nimish performed a total of 156 RRPs in 2015 with a blood transfusion rate of 1.3%, and overall positive margin rate of 11.5% (positive margin for pT2 disease of 4%). His expertise and experience in robotic surgery has attracted increase in referrals from across the UK.

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