Impact of surgeon and volume on extended lymphadenectomy at the time of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium (IRCC)

• Type of Material: Article
• Authors: Susan J Marshall, Roswell Park Cancer Institute; Matthew H Hayn, Maine Medical Center; Andrew P Stegemann, Roswell Park Cancer Institute; Piyush K Agarwal, National Cancer Institute, Bethesda; Ketan K Badani, Columbia University; Derya M Balbay, Memorial Şişli Hospital; Prokar Dasgupta, Guy’s Hospital and King’s College London; Ashok K Hemal, Wake Forest University; Brent K Hollenbeck, University of Michigan Health System; Adam S Kibel, Washington University; Mani Menon, Henry Ford Health System; Alex Mottrie, Onze-Lieve-Vrouw Ziekenhuis; Kenneth Nepple, Washington University; John Pattaras, Emory University; James O Peabody, Henry Ford Health System; Vassillis Poulakis, Doctor’s Hospital, Greece; Raj S Pruthi, University of North Carolina; Joan Palou Redorta, Fundacio Puigvert; Koon-Ho Rha, Yonsei University; Lee Richstone, The Arthur Smith Institute for Urology; Francis Schanne, Urologic Surgical Associates of Delaware; Douglas S Scherr, Weill Cornell Medical Center; Stefan Siemer, University Clinics of Saarland; Michael Stöckle, University Clinics of Saarland; Eric M Wallen, University of North Carolina; Alon Z Weizer, University of Michigan Health System; Peter Wiklund, Karolinska University Hospital; Timothy Wilson, City of Hope and Beckman Research Institute; Michael Woods, Loyola University; Khurshid A Guru, Roswell Park Cancer Institute
• Language: English
• Date: 2013-06-01
• Publisher: WILEY-BLACKWELL
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 BJU International
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1464-410X.2012.11583.x
• Title of Journal or Parent Work: BJU INTERNATIONAL
• Volume: 111
• Issue: 7
• Start Page: 1075
• End Page: 1080
• Keywords: EXPERIENCE; INVASIVE BLADDER-CANCER; bladder cancer; CARCINOMA; LYMPH-NODE DISSECTION; Life Sciences & Biomedicine; OUTCOMES; lymphadenectomy; ASSOCIATION; Urology & Nephrology; SURVIVAL; robotics; YIELD; cystectomy; Science & Technology

Abstract

Objective To evaluate the incidence of, and predictors for, extended lymph node dissection (LND) in patients undergoing robot-assisted radical cystectomy (RARC) for bladder cancer, as extendedLND is critical for the treatment of bladder cancer but the role of minimally invasive surgery for extended LND has not been well-defined in a multi-institutional setting. Patients and Methods Used the International Robotic Cystectomy Consortium (IRCC) database. In all, 765 patients who underwent RARC at 17 institutions from 2003 to 2010 were evaluated for receipt of extended LND. Patients were stratified by age, sex, clinical stage, institutional volume, sequential case number, and surgeon volume. Logistic regression analyses were used to correlate variables to the likelihood of undergoing extended LND. Results In all, 445 (58%) patients underwent extended LND. Among all patients, a median (range) of 18 (0-74) LNs were examined. High-volume institutions (≥100 cases) had a higher mean LN yield (23 vs 15, P < 0.001). On univariable analysis, surgeon volume, institutional volume, and sequential case number were associated with likelihood of undergoing extended LND. On multivariable analysis, surgeon volume [odds ratio (OR) 3.46, 95% confidence interval (CI) 2.37-5.06, P < 0.001] and institution volume [OR 2.65, 95% CI 1.47-4.78, P = 0.001) were associated with undergoing extended LND. Conclusions Robot-assisted LND can achieve similar LN yields to those of open LND after RC. High-volume surgeons are more likely to perform extended LND, reflecting a correlation between their growing experience and increased comfort with advanced vascular dissection. © 2013 BJU International.