Impact of surgeon and volume on extended lymphadenectomy at the time of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium (IRCC)
Por:
Marshall, SJ, Hayn, MH, Stegemann, AP, Agarwal, PK, Badani, KK, Balbay, MD, Dasgupta, P, Hemal, AK, Hollenbeck, BK, Kibel, AS, Menon, M, Mottrie, A, Nepple, K, Pattaras, JG, Peabody, JO, Poulakis, V, Pruthi, RS, Redorta, JP, Rha, KH, Richstone, L, Schanne, F, Scherr, DS, Siemer, S, Stockle, M, Wallen, EM, Weizer, AZ, Wiklund, P, Wilson, T, Woods, M, Guru, KA
Publicada:
1 jun 2013
Resumen:
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.
Filiaciones:
Marshall, SJ:
Roswell Pk Canc Inst, Dept Urol, Buffalo, NY 14263 USA
Hayn, MH:
Maine Med Ctr, Dept Urol, Portland, ME 04102 USA
Stegemann, AP:
Roswell Pk Canc Inst, Dept Urol, Buffalo, NY 14263 USA
Agarwal, PK:
NCI, Dept Urol, Bethesda, MD 20892 USA
Badani, KK:
Columbia Univ, Dept Urol, Med Ctr, New York, NY USA
Balbay, MD:
Mem Sisli Hosp, Dept Urol, Istanbul, Turkey
Dasgupta, P:
Guys Hosp, Dept Urol, London SE1 9RT, England
Kings Coll London, Sch Med, London WC2R 2LS, England
Hemal, AK:
Wake Forest Univ, Dept Urol, Baptist Med Ctr, Winston Salem, NC 27109 USA
Hollenbeck, BK:
Univ Michigan Hlth Syst, Dept Urol, Ann Arbor, MI USA
Kibel, AS:
Washington Univ, Sch Med, Dept Urol, St Louis, MO USA
Menon, M:
Henry Ford Hlth Syst, Dept Urol, Detroit, MI USA
Mottrie, A:
Onze Lieve Vrouw Hosp, Dept Urol, Aalast, Belgium
Nepple, K:
Washington Univ, Sch Med, Dept Urol, St Louis, MO USA
Pattaras, JG:
Emory Univ, Sch Med, Dept Urol, Atlanta, GA USA
Peabody, JO:
Henry Ford Hlth Syst, Dept Urol, Detroit, MI USA
Poulakis, V:
Doctors Hosp, Dept Urol, Athens, Greece
Pruthi, RS:
Univ N Carolina, Dept Urol, Chapel Hill, NC USA
Redorta, JP:
Fundacio Puigvert, Barcelona, Spain
Rha, KH:
Yonsei Univ, Hlth Syst Severance Hosp, Dept Urol, Seoul 120749, South Korea
Richstone, L:
Arthur Smith Inst Urol, Dept Urol, New York, NY USA
Schanne, F:
Urol Surg Associates Delaware, Dept Urol, Newark, DE USA
Scherr, DS:
Weill Cornell Med Ctr, Dept Urol, New York, NY USA
Siemer, S:
Univ Clin Saarland, Dept Urol, Homburg, Germany
Stockle, M:
Univ Clin Saarland, Dept Urol, Homburg, Germany
Wallen, EM:
Univ N Carolina, Dept Urol, Chapel Hill, NC USA
Weizer, AZ:
Univ Michigan Hlth Syst, Dept Urol, Ann Arbor, MI USA
Wiklund, P:
Karolinska Univ Hosp, Dept Urol, Stockholm, Sweden
Wilson, T:
City Hope Natl Med Ctr, Dept Urol, Duarte, CA USA
City Hope Natl Med Ctr, Beckman Res Inst, Duarte, CA 91010 USA
Woods, M:
Loyola Univ, Med Ctr, Dept Urol, Maywood, IL 60153 USA
Guru, KA:
Roswell Pk Canc Inst, Dept Urol, Buffalo, NY 14263 USA
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